Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What small bowel dose constraints do you use when treating with short course radiation for rectal cancer?
In my experience, I have set a small bowel max of 25 Gy; sometimes allowing up to 27 Gy. This was out of an abundance of caution; our initial experience (1) was with 20 Gy/5 fractions and there was concern about increasing the radiation dose to 25 Gy. Also, we wanted to make sure that patients with ...
What do you tell men with low but detectable PSA who have completed ADT and RT?
Several analysis have shown that patients who do not achieve undetectable PSA levels after 6 months of ADT have worse outcomes. This is a bit of a moving target and the definition of undetectable has changed over the decades. An important question is - are these patients failing due to incomplete lo...
What is the role of radiation in a patient with stage IV DLBCL with bilateral testicular involvement?
I tend to loosely recommend consolidation RT to the testicles in this situation if in CR. This recommendation is based on pattern-of-failure studies in primary testicular lymphoma where prophylactic contralateral testes RT is usually recommended, and the principle that the testicles are a sanctuary ...
How would you approach the treatment of a low grade adnexal carcinoma of the scalp in a patient with prior history of WBRT as a child?
Post-op RT and RT alone for the second one, if surgery is not an option. No hypofractionation.
How would you manage the cavity of a resected anaplastic meningioma with pulmonary metastases?
Metastatic meningioma outside the CNS is rare, and its incidence has been estimated to be 0.1% with the lung being the most common site for distant metastases (Surov et al., PMID 23404622). There is no clear standard therapy for the management of metastatic meningioma. Suppose this was an anaplastic...
Is radiation therapy a treatment option for refractory Paget's disease of the vulva extending onto skin of buttocks and anal margin?
I have treated localized peri-anal Paget's Disease with good outcomes, and there is some data to support this. I have not treated a patient with such widespread vulvar Paget's and I suspect that the morbidity would be significant given the doses required, and the volume to be treated in the case you...
How do you approach treatment of vulvar cancer with bulky lymph node metastasis?
PET CT. Plan definitive chemo (weekly cisplatinum) with IMRT, with a dose of about equivalent dose of 66 Gy to GTVs. Reassess after 6-8 weeks for excision or bx of any residual disease. Dose-Escalated Intensity Modulated Radiation Therapy in Patients with Locally Advanced Vulvar Cancer- Does It Incr...
What would be the recommended management for patients with rectal adenocarcinoma with rectovaginal fistula at presentation?
Diverting colostomy, preop RT chemo, and surgery.
How would you approach therapy in a young adult with synovial sarcoma of the head and neck who is not amenable to surgery due to location on the face?
I do not think primary synovial sarcoma is curable without surgery. I have never seen a durable response in a tumor treated with radiation alone. Synovial sarcoma responds to ifosfamide based chemotherapy generally, but in my experience, the response rates for primary tumors are lower than response ...
Would the diagnosis of skin-only morphea (localized scleroderma) alter treatment recommendations for localized anal cancer?
There is enough data about the acute and late toxicity from radiation in these patients to be concerned. However, none of it rises to the level of the toxicity of APR. Therefore, my approach would be to involve the patient in the decision, document, and reduce the dose by 10%.