Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
How do you counsel patients regarding antioxidant use during their course of RT?
I'm not sure there is a precise answer to this question, specifically in regards to dosages / types of antioxidants. Yes, it is probably better just not to take them. There are likely harms and no level 1 evidence to suggests benefits at this time. If you were interested in more details: Specificall...
Have we established standard doses for radiation therapy for H&N cancers?
You've asked a *really* wide-ranging, thought-provoking question. That said, if by 70 Gy you mean 35 fractions of 2 Gy apiece over 7 weeks as *the* "optimal dose," I can think of a few references off the top of my head where that's not optimal per se. Dosing also entails the timing/frequency of dose...
What challenges and adverse effects have you encountered with SpaceOAR injection?
Only situation in our limited experience where we have encountered a problem is in a patient with inflammatory bowel disease that had a j pouch where the scarring limited optimal placement of the SpaceOAR and the separation between the rectum and prostate was not as desired.
What is your preferred dose-fractionation regimen when treating high-risk SCC of the skin in elderly and/or frail patients?
Treatment considerations for patients with cutaneous squamous cell carcinoma are multifaceted and require assessment of patient (age, transportation logistics, desired cosmetic outcomes), disease (size, location), and treatment factors (electron energy, cut-out size, bolus, choice of prescription is...
Would you offer radiation to an elderly patient with DCIS who would otherwise not meet criteria for RTOG 9804?
I counsel elderly patients with DCIS about the risks and benefits of receiving radiation therapy. I offer radiation in patients with excellent performance status who are uncomfortable with the 1-2%/year recurrence risk with omission of radiation (extrapolating from RTOG 9804 as well as ECOG (Solin e...