Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What techniques do you use to treat patients who weigh more than the treatment table limit?
In our institutional experience, this weighty question arises more often than we would prefer and most commonly for cervical cancer patients. If the patient is only nominally beyond the limit, it is important to consider that the weight limits are consequent to the tolerance parameters of the motors...
How do you handle pregnancy testing for women of childbearing age?
When ordering a simulation we denote whether a pregancy test is needed. If so, it is performed before the simulation takes place. Department policy dictates that all women of childbearing age have a serum pregancy test before the simulation CT scan (excecpt those unable to get pregnant, for example ...
What adjuvant therapy (chemotherapy, radiation) do you recommend for incidentally found focus of small cell prostate cancer at time of radical prostatectomy?
This is an interesting question. Extrapolating from the relatively recent data on surgery for early SCLC, the local therapy for an incidental focus of small cell histology has been completed after RP. If there is tumor that penetrated through the capsule, I'd look at the amount of tumor that broke t...
Do you routinely obtain surveillance brain MRI studies after PCI?
In ED, this was the subject of debate with 2014 ASCO finding of worse survival post PCI. Recent 2016 in Vienna Update, no OS benefit, but no detriment either. Japanese ethnicity may respond differently...more respiratory toxicity has been noted as well as worse somnolence. In LD, where PCI improve...
How do you manage radiation induced serous otitis media?
In my practice, we routinely limit the cochlea to 30 Gy. Usually, this is achievable in all but the most extensive nasopharyngeal patients.In this context, we have approximately a 10% rate of symptomatic serous otitis media. These symptoms are usually mild and do not require therapy. However, in pat...
Do you consider consolidating the chest for patients with extensive stage SCLC with brain metastases with a PR/CR after whole brain RT and systemic chemotherapy?
The obsession with survival, both for payment and utility, interferes with some benefits of XRT in ED. Many want to undo Slotman's two observations: incredible improvement in 1 year survival and brain freedom from failure despite persistence of disease in the chest; and improved 2 year survival in E...
When, if ever, would you consider adjuvant pelvic radiation after chemotherapy for a completely resected localized (Stage I - II) clear cell carcinoma of the ovary?
We do consider for early stage clear cell ovarian cancer after surgery and chemotherapy with Canadian data showing a survival advantage with WAR. We, in practice, consider pelvic RT only although these patients are still very infrequently referred by Gyn oncologist http://jco.ascopubs.org/content/ea...
How do you manage moist desquamation when treating breast cancer?
In my experience treating patients with breast cancer, those undergoing postmastectomy radiation and patients with surgically unresectable gross chest wall disease who require use of bolus, are most likely to develop moist desquamation. I agree that for patients undergoing adjuvant postmastectomy ra...
Do you routinely perform an axillary ultrasound in women with newly diagnosed breast cancer without palpable axillary nodes?
The practice has changed a bit with Z11 and AMAROS. For all invasive cancer we do perform sonogram but ifthe nodes are not palpable but only suspicious on ultrasound we don't routinely perform a percutaneus bx. The idea is these patients are still suitable for SLNB and were included in Z11. SLNB wou...
Do you offer SRS to patients with SCLC who have intracranial relapses after prior WBRT?
I do. We wrote up a couple of series on our experience with this a few years back using both GK and linac based systems. https://www.ncbi.nlm.nih.gov/pubmed/23174724https://www.ncbi.nlm.nih.gov/pubmed/21345622