Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?
The incidence and the timeframe of the development of radiation myelopathy are influenced by total radiation dose, radiation dose per fraction, time between courses of radiation, and associated chemotherapy or immunotherapy. Older age, the presence of diabetes, and previous exposure to radiation are...
Is there a role for selective arterial embolization of RCC before primary SBRT?
An interesting question! A good way to approach this question is with a list of potential advantages and a list of potential disadvantages. For the record, this is all hypothetical. I am not aware of any published literature that has explored this concept.Advantages: Significantly reduce the size of...
In a patient with anorectal SCC, T2N0, with a history of bladder prolapse managed with pessary, would the pessary need to be removed prior to radiation?
I don't see a problem having a pessary in place at the time of each treatment, if the patient needs it in place in order to function. To reduce the risk of long-term vaginal stenosis, these patients should also have a vaginal spacer inserted at the time of each radiation treatment to better spare th...
How would you approach radiation for node-positive prostate cancer in a patient with an aortic and/or common iliac arterial aneurysm not meeting criteria for surgical repair?
Literature has shown a correlation of brain irradiation associated with the development of intracranial aneurysms - I believe that is the concern this question is raising.The good news is that other studies have shown that, at least for the aorta, existing large artery aneurysms are not worsened by ...
How do you decide between stereotactic arrhythmia radiation (STAR) and repeat catheter ablation in patients with refractory ventricular tachycardia who have already failed one prior ablation?
This is a great question and something that the ongoing RADIATE-VT trial is working to answer (NCT05765175). In this phase III RCT trial, recurrent VT patients who have had at least one prior catheter ablation, are considered to be candidates for a repeat catheter ablation by their electrophysiologi...
What is your radiotherapy plan for recurrent midline epidermoid cyst after resection around 10 months ago?
Radiotherapy for suprasellar epidermoid cysts is typically reserved for rare, recurrent, or malignant cases where surgical resection is not feasible. While microsurgical removal is the standard, adjuvant radiotherapy (conventional or stereotactic/Gamma Knife) can effectively manage residual or recur...
What hypofractionated regimens would you consider for postoperative SCC of the hand with a positive margin?
I have started to use 50 Gy in 20 fractions in all patients with a recent retrospective analysis from Australia for cutaneous squamous and basal cell cancers that has been used for head and neck patients, another sun-exposed site with cosmetic concerns. This type of question is hard to answer as man...
For locally advanced NSCLC, does endobronchial tumor debulking just prior to treatment influence your decision making regarding bronchial tissue constraints/expected toxicity?
Bulky, large endobronchial lesions both bleed and obstruct. The concern should be the length and depth of the tumor. If destruction of the trachea or bronchial tumor risks bleeding and B/P fistula, it may account for some of the hazards associated with “ultra-central” location. The endobronchial deb...
What is your treatment approach for a pediatric patient with H3K27M-mutant diffuse midline glioma following progression after radiation therapy?
First, if the patient is at least six months from initial radiation and has had a reasonable initial response, reirradiation is the best proven treatment for recurrence. We would also encourage enrollment on a clinical trial (the DMG National Tumor Board is a helpful resource for determining for whi...
Does non-urothelial histology impact your approach to chemoradiotherapy for muscle-invasive bladder cancer?
There is no randomized data available in this regard to guide us through non-urothelial histologies for MIBC. However, certain points that are worth considering in their management are: For small cell or neuroendocrine tumors, cisplatin/etoposide or ifosfamide/doxorubicin-based systemic therapy in ...