Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you consider 10MV beams safe in a patient with an implantable cardiac device?
I follow the AAPM TG-203 which considers beams up to 10 MV photons to be non-neutron producing. For example, in a lung, abdominal, or pelvis tumor, I find the reduction in total body dose worthwhile to use 10 MV.
What dose can you give the axilla after 5040 cGy of prior radiation?
I have cases where the patient has previously received axillary RT (45-50 Gy usually) and end up with a recurrence where we would like to re-RT. If they have surgery and have factors such as multiple nodes, ECE, I will re-irradiate to a dose of 45 Gy/1.8 Gy fx. There are data suggesting low rates of...
How do you decide between whole brain radiotherapy vs partial brain irradiation vs SRS for treatment of CNS metastases?
Many factors are at play in choosing WBRT vs. SRS: number, size, and location of the brain metastases – goals of care/patient wishes/comorbidities — pace of the disease, histology, concurrent therapy — to name only the main factors... In the end, it often is usually a subjective recommendation for a...
What dose do you recommend in adjuvant setting following R0 resection of Sinonasal undifferentiated carcinoma (SNUC) involving paranasal sinuses/nasal cavity and close proximity to eyes?
60 Gy to primary site and 50 Gy to neck with protons.
What is the preferred radiation delivery technique for whole abdominal or flank RT in childhood cancers?
The rationale for using less sophisticated techniques to treat flank and whole abdominal fields has largely been centered on reducing the potential for growth discrepancies by treating with homogeneous doses across bony structures, most notably the spinal column and pelvic bones. The use of AP/PA fi...
Are you using the commercially available Naveris assay for HPV+ OPX cancers in your practice?
Our practice at Emory is to get this at initial consult for all HPV+ oropharyngeal cancers so that we can establish if ctHPVDNA is positive (as it is not positive in all HPV+ cases). Right now, I find it most useful at the three month scan in equivocal cases, a negative ctHPVDNA leads us more towar...
How would you approach a patient with gastric MALT lymphoma who has CREST syndrome?
The quick answer is, very carefully. To elaborate - I first had to look up what CREST syndrome is - the short answer is limited extent scleroderma, usually the distal upper and lower extremities, but occasionally the head and neck region and most relevant to this question, the esophagus. The literat...
How would you approach the treatment of an elderly patient with dementia, with multifocal pT1b IDC s/p lumpectomy, with extensive DCIS, and medial margin positive for DCIS?
It would be a function of her expected survival from dementia (geriatric assessment) and will her breast cancer be an issue in her lifetime based on the assessment. Based on that option, could be nothing to AI or RT.
When do you use a bite block for H&N cases?
It’s remarkable that despite all the technological advancements in radiation delivery, simple oral management solutions can make a bigger impact on the dosimetry. They have two primary functions: Create favorable anatomic relationships for OAR sparing Enhance stability and reproducibility ...
When do you include the neck in the RT field for resected thyroid cancer?
I will use external beam RT to the neck for medullary thyroid cancer, anaplastic thyroid cancer, or local-regional recurrence of papillary or follicular that is no longer iodine-avid, and thus cannot be treated by I-131.