Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your surveillance strategy for locally advanced HPV+ oropharynx cancer after PET CR?
PET scan at 12 weeks after chemoradiotherapy. Endoscopic exam by ENT q 2-3 months in year 1; q 3-4 months in year 2; q 6 months in years 3-5. I reiterate time and again the importance of these in light of temporal pattern of local recurrence for HNSCC (usually in first 1-2 years). If appreciate any...
For women receiving breast RT who develop a severe skin reaction during treatment, what is your threshold for giving a treatment break?
I would for symptomatic grade 3 Reaction although in era of hypofractination it is very uncommon. Sometimes would do boost RT in the break period
How would you manage palliation in a patient with postobstructive pneumonia caused by a mediastinal mass?
I'm guessing you're thinking of a lung cancer patient with hilar obstruction, lobar atelectasis, and 2nd pneumoia. These patients often get great palliation from RT. The primary challenge is finding the obstructing mass (which benefits from RT) and separating it from the infection (doesn't benefit)....
What are the best strategies to obtain good simulation CT imaging for prostate cancer patients who have had hip replacements?
For bilateral hip replacements, I have obtained/fused a cone beam CT as it often does not have as much artifact, and also fused an MRI with the cone beam image.
Do you think it makes a difference to fractionate at 2 Gy versus 1.8 Gy per fraction?
This is a great question and is an example of how a single clinical decision can change practice. In the era of radiation alone the standard fractionation was 2 Gy/day. With the introduction of concurrent chemoradiation the radiation dose was decreased to 1.8 Gy/day. This 10% dose attenuation was su...
When do you recommend PMRT for individuals with spindle cell carcinoma of the breast?
These cancers are in a broad category of metaplastic cancer of the breast. They are triple negative but are not chemoresponsive like ductal triple negative breast cancer and tend to have poor outcome. Our threhold for adding RT is lower in these patients.
When would you consider using radiation for cardiac metastases?
I would consider it if it's likely to be effective based on histology. If it it a relatively radioresistant tumor, I would consider if there's no other viable option.
What is a standard field for LN+ paratesticular rhabdomyosarcoma (ie aorta + ivc + ipsi common iliac)?
Though there is some variation, most clinicians who have enrolled patients on the IRSG or COG studies use a "hockey-stick" field that parallels what would be used for seminoma. These would include the para-aortic and ipsilateral iliac nodes. A minority of clinicians exclude the iliac nodes if they a...
What is your method for delineation of the hippocampal avoidance structure in patients who are unable to undergo MRI?
The hypothetical benefit of conformal avoidance of the hippocampus during cranial irradiation centers on the memory-specific and radiosensitive neural stem cell compartment within the hippocampal dentate gyrus. The hippocampal dentate gyrus is a gray matter structure surrounded by white matter struc...
How does your prescribed SRS dose vary with cavity size for treatment of resected brain metastases?
I generally follow SRS dose for postop cavities as I do for unresected lesions. 20 Gy for < 2cm, 18 Gy for <3 cm, and 16 Gy for <4cm. For tumors greater than 3 cm I have been favoring hypofractionated RT.