Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For a small (<5 mm) hard/soft palate junctional primary with DOI <2 mm status post limited excision with negative but close deep margin, how would you approach neck management in the adjuvant RT setting?
Postop RT to primary plus elective neck RT.
Do you recommend PMRT and if so, do you treat the regional nodes, in patients who are cT4N0 (non-inflammatory) treated with neoadjuvant chemotherapy who have a pCR at the time of mastectomy?
I would recommend PMRT and treat chest wall and regional node comprehensively. At present those who present with clinical stage III disease like above and have pCR we recommend PMRT. Some of them are suitable for B51 also (stage III and node positive upfront converted to node negative) and we do off...
What is your preferred palliative radiation regimen for patients with painful bone metastasis?
Because of the great work of the BM Working Group led by Hartsell et al, and the Dutch, for examples, there are ample category 1 data supporting the use of Single Fraction (800cGyx1) EBRT for "uncomplicated" bone lesions. That is, the use of 800cGy x1 unless there is: a soft tissue component, an imp...
Do you do urethrogram at time of prostate simulation?
We don't perform a urethrogam. We do MRI with a pelvic coil and fuse it with the CT scan which helps to identify the base, lateral edge and apex appropriately.
In what settings do you routinely image the spine for work-up of an intracranial glioma?
I do not routinely image the spine following workup of an intracranial glioma. It is not because they are not common because in fact, it can be found in 25% of patients with supratentorial glioblastoma (Kaloshi et al. Acta Inform Med 2014). Rather, symptomatic spinal dissemination occurs in less tha...
What is your approach for a brachytherapy boost in prostate cancer patients with extracapsular extension?
In general for patients with documented extracapsular extension, the combination of external beam radiation along with brachytherapy is a very appropriate treatment intervention. For such patients, we generally initiate treatment with the brachytherapy and make sure that seed placement is well cover...
How do you approach isolated recurrence in a para-aortic lymph node following definitive radiation for localized prostate cancer?
This is a challenging situation with no data to guide therapy; it is not unreasonable to pursue novel PET imaging (PSMA on trial, fluciclovine) to ensure there is no evidence of other sites of metastatic disease. The treatment of oligometastatic disease continues to evolve. In this situation, I woul...
Do you routinely treat postoperative extremity soft tissue sarcoma with IMRT?
Historical tidbit: In the early days of IMRT, and I'm talking like ~2000-2003, there were actually approved diagnosis codes for IMRT (oropharynx was allowed e.g.). There were likewise codes that were exclusionary for IMRT (I remember breast and gastric cancer e.g. being disallowed early on). Soft ti...
Would obtaining a breast MRI for patients going to be treated with APBI be beneficial?
The published outcome data for APBI does not suggest routine use of MRI as part of the work up and have shown a low local recurrence rate. A recent randomised published study by GEC estro also did'nt mandate MRI as part of work up and showed low recurrence rate and equivalent outcome to whole breast...
What is your approach to left sided PMRT in patients with on-going cardiac issues (ie. cardiomyopathy, heart failure, coronary heart disease)?
In this circumstance, like for any medical intervention, we need to carefully weigh the risks and benefits of treatment. The likelihood of radiotherapy-induced cardiac injury appears to dependent on two variables: 1) Cardiac dose. This is variably defined - I think mean heart dose may be the best su...