Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Would you consider RNI alone without CW for an isolated nodal recurrence after treatment with mastectomy and SNB for an early-stage breast cancer with no prior RT?
I favor comprehensive RT unless there are contraindications or the patient declines because of the impact on cosmetic outcome.
Does radiation therapy (ex. to the breast) in patients with CDK4 mutations increase the risk of developing melanoma?
I am unaware of any literature supporting the fact that RT in patients with CDK4 mutations increases the risk of melanoma development. There have been studies, with conflicting results though, looking at whether there is any increased risk or incidence of melanoma in patients with breast cancer wh...
What vertebral body dose constraint do you use in SBRT to limit compression fracture?
Vertebral body compression fracture after stereotactic radiation is a complicated topic with multiple contributing factors. Different institutional analyses have demonstrated lytic tumors, bony involvement by tumor >40%, age >55, pre-treatment pre-existing fracture, histology, spine deformity, and d...
Do you offer low-dose radiation therapy for osteoarthritis of the spine?
DEGRO has published guidelines on this very topic, so I would respectfully disagree with a comment arguing a lack of data. Of course, if one is looking for level 1 data on irradiating benign diseases in general, there may be little to satisfy.That being said, there's no level 1 data espousing the be...
What is your strategy to prevent and treat constipation in patients initiating or receiving opioids?
I am a radiation oncologist and palliative care physician.I teach: "the hand that writes the opioids, writes the laxatives - or else it does the disimpaction". Opioid induced constipation is very common, can cause physical and psychological discomfort, and have a major impact on quality of life. It ...
Which GI cancer patients do you use oral contrast in staging CT scans?
We do not use oral contrast for most of our patients and only offer oral contrast CT scans for patients we are concerned about perforation.
What is the optimal treatment of medically inoperable T3N0 non-small cell lung cancer that is too large for standard SBRT?
As we see it, there is more than one way to skin the cat. RTOG 0617 has condemned protracted fractions to 70 Gy...it just might be that 70 Gy is the wrong way to treat in 35 fractions, +/- cetuximab added to weakly carbo taxol. But the study to look at thoracic dose is contaminated by those systemic...
What duration of ADT do you recommend for a patient with locally treated prostate cancer who undergoes metastasis-directed radiation therapy to a single oligometastatic bone lesion?
While I agree with @Dr. First Last that very small studies like STOMP and ORIOLE suggest that a small subset of men can delay the need for ADT by 1-3 years, this is not level 1 evidence. Most men with oligometastatic HSPC will still progress with metastasis directed therapy alone over a short time h...
Is central lumpectomy always required for Paget's disease of the breast?
Radiation without surgery for patients with Paget's disease was abandoned decades ago, but perhaps unfairly. Several groups in the pioneering era of breast-conserving therapy tried this approach. Local failure rates with whole-breast irradiation with or without a boost in patients with disease limit...