Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose regimen would you use to treat a patient with locally advanced esophageal SCC of the mid-esophagus who refuses chemo and surgery, agreeing only to radiation alone?
The 5Y survival of RTOG 8501’s RT alone arm was 0%. They used 64/32 Gy. So... I tend to think that RT alone is purely palliative and generally stick with 40/15 to provide palliation and hopefully some local control. 50/25 not unreasonable, but please don’t use the RT alone arm of the chemoRT vs RT s...
Would you treat a vulvar SCC with definitive chemoRT with 50.4 Gy IMRT then boost the GTV with en face with electrons to ~6400?
There is no "one fits all" for vulvar cancer, which is a complex disease with varying disease presentations. The ideal method of boost and the dose depends on the size, location, histology, and other factors. We used to use en face electron boosts much more frequently before we began using IMRT. It ...
What risk, if any, do you quote for erectile dysfunction in a young male being treated for a lumbosacral ependymoma?
I have not been quoting a specific risk of ED in spinal ependymoma patients. ED is common with advancing age and is often multifactorial. In ependymoma, prior spine surgery, the disease itself, concurrent medication, concurrent health issues, and the psychological impact of a cancer diagnosis are, f...
Would you ever recommend post-op CRT for gastric adenocarcinoma treated with upfront surgery and D2 resection with R0?
I would agree that chemotherapy without radiation is the current standard of care. INT-0116 notwithstanding, the ARTIST trial did not show a benefit to chemoradiation over chemotherapy alone. An unplanned subset analysis suggested a benefit to radiation in node-positive patients. The subsequent ARTI...
For a patient with cardiac sarcoma, is there a minimum ejection fraction to proceed with adjuvant radiation therapy?
Adjuvant radiation therapy is often indicated for cardiac sarcoma because tumor resections are often incomplete or done with close margins. However, cardiotoxicity is a major issue, especially since patients will often receive doxorubicin-based chemotherapy, which has inherent cardiotoxicity. That b...
How would you manage a imaging suspicious undissected (ipsilateral) lymph node in the setting of post-op RT for an oral cavity cancer with extensive nodal disease and ECE?
Chemo RT, 70 Gy to the node, followed by PET CT in 3 months.
Do you routinely prescribe vaginal estrogen therapy post chemo/XRT for female patients finishing anal cancer treatment?
No. We encourage all female patients to use a vaginal dilator and Replens over the counter vaginal moisturizer (vitamin E, B, non-hormonal) after chemoradiation. We also encourage patients to see their gynecologist to discuss topical estrogen therapy. There are potential side effects/drug interacti...
Would you recommend surgery or radiation for newly diagnosed localized prostate cancer diagnosed on a urethral lesion biopsy?
I think the underlying question here is whether its urethral location changes the recommendations we would otherwise make, and really it doesn't. Let's talk it through: I don't feel that the urethral location affects my ability to treat this with EBRT as the urethra gets the same (curative) dose as ...
Would you add dose/fractions to a post-mastectomy patient who had a two week break due to being COVID-19 positive?
There are no data on how treatment breaks impact the effectiveness of PMRT. I doubt a two-week break has a substantial impact in the era of effective systemic therapy, particularly if hypofractionation is used. Having said that, I do tend to add 1 or 2 fractions when there is a treatment break or br...
Would you use inhaled steroids with or without oral steroids for the treatment of radiation pneumonitis?
I have not tried inhaled steroids instead of oral steroids for symptomatic radiation pneumonitis much in my practice. Many patients are already on inhaled steroids at baseline, and many who develop pneumonitis have severe symptoms. That being said, avoiding oral steroids could be particularly import...