Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you account for artifact due to hardware, or what measures do you take, to optimize planning in the setting of a post-operative spine SBRT treatment?
The most difficult issue from artifact from hardware is adequately seeing the spinal cord for proper delineation. In order to properly see the cord in cases where artifact from MRI obscures the cord, we typically obtain a CT myelogram and fuse that with our simulation CT to allow us to draw out the ...
Does p16 status influence your decision when choosing between surgery and definitive chemo-RT for head and neck patients?
I am assuming that when you say "surgery" you are specifically referring to transoral robotic or transoral laser surgeries and not the traditional mandible- splitting surgeries for oropharyngeal cancers.Currently p16 status does not make a difference in offering transoral surgery to patients. FDA ap...
How would you treat small cell cancer of the cervix?
Small cell carcinoma is a rare tumor, representing less than 3% of all cervical cancers. It is tremendously different from the more common squamous and adenocarcinomas of the cervix both in terms of histological identification and its clinical course. Due to its rarity and variable inclusion on prev...
In what situations should chemotherapy be added to adjuvant radiation therapy in a resected vuvlar SCC?
We did analysis from NCDB and saw significant trend of use of concurrent chemotherapy for node positive disease and its positive impact on survival. That being said these studies have their own flaws. In practice we do add concurrent cisplatinum for node positive patients if performance status allow...
Are there technical alternatives to SRS for a radiation center without the requisite micrcollimator or cones, for patients with early crainal merastases?
I would consider fractionated stereotactic radiotherapy if microcollimator or cones were not available for limited brain metastases.
What is the risk of breast cancer that you quote to young women with early stage Hodgkin's lymphoma receiving involved field/site radiation therapy?
The risk depends on many different factors, including the amount of breast exposure to radiation, age of the patient, chemotherapy regimen, etc. Patients at greatest risk are likely those with axillary involvement who are < 30, where a large portion of their breast maybe unintentionally irradiated. ...
How do you treat hiccups in cancer patients?
Personal success has lead me to use Baclofen to control chemotherapy induced hiccups. A single 10 mg dose is usually effective for patients who experience hiccups upon administration of chemotherapy. Occasionally 10 mg q 8 h prn is needed for a few doses. I have seen this side effect and used Baclof...
What situations do you use IMRT vs 4-field box technique (or visa versa) for patients with an intact cervix with no pelvic or para-aortic nodal involvement?
The main argument is sparing of small bowel and marrow dose. Comparing the dosimetry of the two plans would give the answer as to whether there is any advantage in a particular patient as it varies based on anatomy, BMI, size of uterus and disease
Is there ever a situation where you would recommend radiation after gross total resection of a craniopharyngioma?
I favor observation.
Do you treat pre- or post-operatively for HO prophylaxis?
At our institution, we typically treat postoperatively rather than preoperatively, although many studies have shown preoperative to be as effective as postoperative. That said, there is one study by Seegenschmeidt et al reported in IJROPB in 1997 that showed preopeartive was less effective for Brook...