Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend using DIBH for young adults with Hodgkin lymphoma who require mediastinal RT?
AS a general rule, sophisticated RT planning techniques are very useful for some patients but hardly necessary for all. This is particularly true for lymphoma pts where doses are often low, such as favorable HL where 2 cycles of ABVD and 20 gy is the treatment of choice ( see Dr Kelsey's answer to a...
Do you omit the breast boost in patients with lumpectomy bed near the nipple areolar complex?
In patients treated with breast conservation where a boost is indicated and the boost volume would include the nipple-areolar complex, yes I would proceed with a radiation boost. In my experience, although acute skin reactions and some additional acute discomfort may be associated with the boost in ...
How would you approach treatment in patients with stage III non small cell lung cancer invading the atrium of the heart?
Thank you for the question. I would refer to our case report from ~ 6 years ago. Link here:Atrial mass from NSCLC treated with radiotherapy in BJ Radiology. I think the short answer is that generally you have to treat it, and the best option is radiotherapy +/- chemotherapy. Modern radiotherapy is s...
Do you differ your PMRT treatment if a patient had a nipple sparing mastectomy?
I usually follow same principal and limited published data has not higher complications or nipple loss with use of RT
How do you manage cavernous sinus meningiomas?
Radiotherapy or radiosurgery depending on optic nerve dose
How do you approach patients with squamous cell carcinoma of anal canal with ano-vaginal fistula?
Try diversion colostomy, treat and see if it heals
How do you prevent/treat nasal synechiae after radiation for SCC of nasal vestibule?
Vaseline Q tips and nasal douche during and after RT. Bring in weekly after RT, if necessary, to lyse synechiae with Vaseline Q tips
What is your surveillance imaging schedule after whole brain radiotherapy for brain metastases?
I would integrate any follow up schedule within the patient’s plan of care. If you don’t have a plan in the setting of asymptomatic progression within the brain, then why get the MRI? Most patients receiving WBRT are not great SRS or SRT candidates, but if progression means the patient could receive...
How important is a severely diminished diffusion capacity in determining whether to offer a lung cancer patient radiotherapy?
Conventionally, Pulmonary function tests (PFTs) are considered essential before considering thoracic surgery and by extension this rule has applied to definitive radiation. This is because baseline pulmonary function (PF) can predict the risk of pulmonary complications after thoracotomy, and patient...
Do you recommend elective mediastinal nodal irradiation for an inoperable NSCLC patient with N1 disease who is unable to undergo mediastinal staging?
I think that for N1 patients, the risk of developing mediastinal nodal recurrence is high and it is possible that irradiating the mediastinum would reduce this risk, but I don’t think that there are any good studies that sufficiently address this. The patterns of recurrence studies below have grea...