Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you include the dural tail when treating benign meningioma with SRS?
Usually not; it is not common for the dural tail to be directly involved by tumor; however, in some cases, one can visualize tumor approaching the dural tail as distinct from the vascular dural tail, in which case the tumor of course needs to be targeted
What is the biggest mistake people make when performing lung SBRT?
I'm not sure if it's the biggest mistake, but I have seen cases where there could be much steeper dose falloff outside the PTV if the planners had allowed for a hotter hotspot in the center of it. In cranial SRS the initial idea was to prescribe to the isodose line in the beam penumbra that covers t...
What is the role of a radiation oncologist in a nuclear disaster?
So I reside in NYC (NY), and following the various attacks on NYC, I decided to join the local NYCMRC - Medical Reserve Corps. It is operated by the NYC health department, and it meets quite frequently. I felt it was something to do to give back to the community I live in, and to be at the table and...
What dose constraint do you use for the female urethra in gynecologic brachytherapy?
In our experience the tolerance is very different as the prostatic urethra and membranous urethra are very different. We have published our limited experience in Brachytherapy. When we do interstitial HDR brachy we limit 0.1 cc to 100 percent or less of what we prescribed. The 2cc concept is not app...
What dose do you use in the adjuvant treatment of desmoid tumors?
The dose range in retrospective data is between 50-60 Gy, with no dose response beyond 60 Gy even for gross disease treated with RT.
Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?
It probably is. Although not proven by randomized trial/s in pediatric patients, the practice is accepted in adults. In children where long term morbidity of radiation therapy is of greater concern, it would not be unreasonable to use involved nodal field in combination with chemotherapy.
Is it feasible to treat craniospinal fields with new generation scanning beam-only proton machines?
Yes, it is feasible to treat craniospinal fields with scanning beam-only technology. Scanning beam proton therapy delivers one discrete Bragg peak "spot" at a time. Large fields require many spots; so treating large fields such as craniospinal fields with scanning beam techniques requires more time ...
Is it preferable to simulate pediatric Hodgkin's lymphoma patients with arms up or akimbo?
We will be moving towards involved site radiotherapy for pediatric Hodgkin lymphoma. Consequently, you may want to match the simulation with the set up of their pre-treatment PET/CT scan (arms up vs arms down). This will allow you to have more certainty regarding the location of axiallary and subpec...
Is it safe to re-irradiate the pelvis after definitive prostate brachytherapy?
Evaluating the brachytherapy dosimetery can be very useful here. It will provide a visual reminder of how conformal such tx can be. The bladder was likely not exposed. Next, if brachytherapy planning software is available, the doses could be reconstructed and superimposed on the new CT sim (if impla...
What is the likelihood of a successful pregnancy following pelvic irradiation?
This is a very important question. The risks on future fertiltiy from radiation therapy to the abdomen/pelvis are twofold.1) Dose to the ovaries. The LD-50 to the ovaries may be as low as 2 Gy, thus the risk of ovarian dysfunction and premature menopause, is high. 2) Dose to the uterus leading to po...