Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you start a vaginal dilator after EBRT to the vaginal canal?
Although I have not reviewed the published data in a while, from my data review ~8 years ago and my own cumulative gynecologic specialty experience, I have fallen into the following paradigm: In the setting of standard EBRT or vaginal cuff brachy, for a patient, in reference to the use of a vaginal ...
What is the best advice you received as a young attending?
Actually I heard this on the interview trail in 1997 from Sam Hellman: First be a good person. Then a good doctor. Then a good oncologist. Then a good radiation oncologist. In that order.
What surrogate(s) do you use to determine toxicity/safety for a SRS plan with numerous metastases?
Before we turn to surrogates let us look at the information that a plan carries and has valuable implications on the quality of the work being done.First we record and report coverage, selectivity, conformity and gradient indices for every patient and every lesion.Second we plan in a consistent mann...
Are there any situations where you would not offer SBRT for an oligometastatic bone lesion from breast cancer?
Many things are learned "the hard way." I have zapped a LOT of bone mets from prostate, breast, and other sites in the oligometastatic setting. One patient had a solitary met from Lung CA n his R humerus. It involved 2/3 of the length and had substantial soft tissue extension. It was 2008'ish and I ...
Is is okay to offer SBRT for central lung tumors in direct contact with the esophagus?
My short answer is: probably not, if you are considering standard regimens like 10Gy x 5. The risk of fistula appears to be significant if you expose the esophagus to full prescription dose. My group described two patients receiving lung SBRT who developed significant esophageal complications (fistu...
For esophageal cancers with large gaps between the primary and PET positive lymph nodes, do you treat the gaps with continuous volumes or only involved areas?
As is true for much in medicine, there is no simple answer to this question. For a patient with a cervical esophageal cancer, perigastric lymph nodes are essentially metastatic. There is no clear dividing line as to when a node is metastatic vs regional disease. We know that for tumors of the lower ...
Would you recommend post mastectomy radiation for a low grade adenoid cystic carcinoma of the breast resected with negative margins?
Generally not. I would consider it if the tumor were exceptionally large relative to breast size and probably would offer XRT if it were ulcerating the skin; otherwise, surgery with negative margins provides adequate local control, and the incidence of nodal involvement with ACC is very low. XRT wou...
Would you recommend adjuvant radiation therapy to a T4N0 colon cancer with invasion into other organs or the abdominal wall status post R1 resection?
Given the relative dearth of data for radiotherapy in the management of T4 colon cancer, one of my residents, Dr. Chris McLaughlin just completed and published a SEER database analysis on this population of patients (McLaughlin et al. Radiother Oncol 2019). He found that only about 5% of patients wi...
Does the presence of thrombus in the sinus affect your decision between fractionated radiation and SRS for recurrent grade 1 meningioma?
The presence of a thrombus in the venous sinuses can be a significant risk factor for post-treatment complications after SRS for meningiomas originating near or attached to the sinuses. Venous sinus thrombosis can be increased by the SRS, leading to venous infarction, which can cause a range of neur...
In patients with vertebral bone metastases, what criteria do you use to select patients for kyphoplasty referral prior to palliative radiotherapy?
In patients with painful malignant verterbral fracture without overt instability or neurogenic compression that would warrant surgical consultation, kyphoplasty can be considered either before or after palliative radiotherapy. Vertebral augmentation to achieve immediate pain relief prior to radiothe...