Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage an endometrial cancer with no (or minimal) myometrial invasion and only a very small focus of disease in a pelvic node?
Eventhough stage IIIC endometrial cancer is the most common sub-stage among locally advanced patients, patients with node positive disease have routinely been combined with other stages for clinical trial purposes (including high risk early stage disease, stage IV, and recurrent disease). This not o...
When would you consider local ablative therapy (e.g. SBRT, surgery) for patients with oligometastatic non small cell lung cancer on immunotherapy?
Definitely would treat this exactly as I do for EGFR or ALK-targeted therapy. If the patient is doing well, and most sites of disease continue to be controlled but one is progressing I would consider local ablative therapy. That being said, I just had a patient doing well with a CR on ipi-nivo for ...
What strategies do you employ to mitigate mucositis related pain during the treatment of head and neck cancer?
The bottom line is there is no magic bullet that works well. I start Glutamine a week before and throughout the duration of the treatment. It seems to delay the onset. I use custom made mouth pieces to reduce dental scatter if possible--that will reduce mucositis I start with over the counter analg...
How would you manage treatment of a cervical cancer in a patient unable to tolerate chemotherapy or an HDR boost due to medical commodities?
The first step is to be absolutely certain that brachytherapy is not feasible. In our experience this is extremely rare. The patient should have a thorough medical evaluation and have their medical conditions optimized as much as possible before the decision is made to withhold these standard elemen...
Is it beneficial to use fiducial markers if you are using daily cone-beam CT for prostate localization?
The answer to this question will be self-evident if one ever tries to align the prostate to the CBCT at the linac console. It's tough enough to contour the prostate on a planning CT, and the inferior quality of CBCT images only makes it harder to know where the base or apex are. This latter point ca...
Do you recommend PMRT and if so, do you treat the regional nodes, in patients who are cT4N0 (non-inflammatory) treated with neoadjuvant chemotherapy who have a pCR at the time of mastectomy?
I would recommend PMRT and treat chest wall and regional node comprehensively. At present those who present with clinical stage III disease like above and have pCR we recommend PMRT. Some of them are suitable for B51 also (stage III and node positive upfront converted to node negative) and we do off...