Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient with a h/o HSIL & VAIN3 and recent colposcopic vaginal biopsies "highly concerning for exophytic pattern squamous cell carcinoma" refusing vaginectomy?
I have treated with image guided brachy. I use MRI for planning and a multichannel cylinder. Our dose is 6Gy x 5 or 7Gy x 5 prescribed to thickness of vagina seen on MRI, (varies across length) respecting doses to critical organs.
What factors do you use to decide between phase based vs. amplitude based gating for lung SBRT?
We have not used amplitude-based gating treatment for several reason, most notably for the consistency & reproducibility of delivery. Some patients also have some trouble with amplitude-based approaches as well. Having said that, in our experience, phase-based treatments often allow for a shorter ti...
In light of the recently published CARMENA trial, is there still a role for cytoreductive nephrectomy in metastatic RCC patients?
Several features of CARMENA make the data not applicable to all mRCC patients with primary in place. These include a large percentage of poor risk/poor PS patients, lack of receiving intended protocol therapy, including delayed nephrectomy in almost 1 of every 5 patients, and a primary tumor burden ...
When treating younger men with anal cancer do you consider dose to the prostate?
Given the proximity of the prostate to a typical anorectal target volume, it would be difficult to completely spare the prostate without increasing the risk of a marginal miss. I would not recommend compromising target coverage to spare the prostateClinical concerns about prostate dose could involve...
How do you manage vaginal dehiscence discovered during vaginal brachytherapy?
You need to withdraw the applicator and keep patient supine. The patient will require admission and emergent surgery to fix the defect, otherwise bowel loops may prolapse through the defect.
Would you recommend modification of radiation dose or fields in a breast cancer patient in which radiation is recommended who has had prior total body irradation?
I have treated few patients and have not modified as total dose with TBI is usually 12 Gy or below only thing I have done is make sure heart and lung constraints are strictly met to reduce additional risk of cardiac or lung morbidity
Aside from ECE or positive surgical margins, when (if ever) would you offer post-operative chemoradiation in patients with squamous cell cancer of the head and neck?
Aside from ECE and positive margins, we also offer postop chemoRT to oral cavity cancer with MULTIPLE risk features: for example, a combination of the following: large tumor, bony invasion, close margins, PNI and LVI. We feel oral cavity cancers are more aggressive and have much worse prognosis if m...
Do you utilize urethral catheterization at the time of simulation for prostate SBRT planning?
The need for a urethral catheter at simulation depends somewhat upon your dosing technique/strategy, and also whether a planning MRI is obtained. The reason for this is the need for a catheter to precisely define the location of the urethra depends on whether there will be dose sufficient to cause i...
What is an appropriate dose for definitive radiation of a stage IE EBV+ polymorphic B-cell lymphoproliferative disorder?
This is a very unusual presentation for EBV associated polymorphic B-cell lymphoproliferative disorder as most cases are seen in the post-transplant or other immune-compromised patients. In immuno-competent patients, this condition is felt to be related to immune senescence. The range of clinical be...
If a patient develops intermittent painless hematuria during standard prostate RT do you attribute this to cystitis or would you work it up further?
While acute mucosal deepithelialization may be to blame, painless hematuria may unfortunately mark the beginning of a conundrum. It's good medicine to always develop a broad DDx and remember that radiation injuries are waste basket diagnoses. It's also wise to start with a UA/UCx, and if negative do...