Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient with bilateral adrenal metastases if SBRT is not an option?
Clarifying question: Why isn't SBRT possible? Even for difficult lesions with direct abutment of the duodenum, other small bowel and stomach dose escalation can be accomplished by generating heterogeneous plans that cool off the dose at the OAR interface. I generally prescribe 40-50 Gy/5 fractions, ...
How would you approach neoadjuvant radiation therapy for an adenocarcinoma of the anus involving the perirectal skin in a patient with a history of total proctocolectomy with an ileoanal J-pouch anastomosis?
I think it is likely that this is a patient with UC. The fact that this is an adenocarcinoma and that it involves the peri-anal skin with a possible positive iliac node means that there is no possibility of preserving the sphincter using surgery. The tumor is likely arising in the residual bowel and...
Would you recommend adjuvant radiotherapy in addition to chemotherapy in gastric adenocarcinoma s/p gastrectomy with a distal positive resection margin?
This is one of the indications for adjuvant chemoRT for gastric cancer. This patient is pT4a, pN2, R1/2 disease, and grade 3. They probably should have gotten peri-operative FLOT4, in which case the path would be ypT4a, ypN2, R1/2. Either way, the NCCN guidelines support the use of adjuvant radiatio...
When do you consider using protons for breast cancer?
I think there is a limited role for protons in breast cancer outside of prospective studies at this time.With respect to partial breast irradiation, while initial trials showed some higher skin toxicities, modern institutional series have shown much better outcomes. That being said, the total number...
How do you manage a seminal vesicle recurrence after prostate brachytherapy?
Finding more of these in the PSMA era. Have managed a few patients with SBRT +/- ADT adjusting dose based on overlapping OAR if needed.
Would you offer adjuvant chemotherapy/immunotherapy for resected pure squamous cell carcinoma (T2-T4 or N+/-) of the renal pelvis?
Primary or pure squamous cell carcinoma of renal pelvis is very rare and the role of adjuvant therapy after surgery is unknown. Squamous cell carcinomas in head-neck, anal and other sites, tend to recur locally. Based on that behavior, I would offer radiation with a sensitizer, preferably weekly cis...
Do you have a size limitation (e.g. >3cm) for offering SRS for pituitary adenomas if OAR tolerances can otherwise be respected?
While pituitary adenoma size plays a role in my decision making for SRS, I would also take into account dose constraints to the optic apparatus. For single fraction, I like to keep my optic nerve and chiasm max dose under 8 Gy. If I am unable to achieve that, I would consider hypofractionation in 3 ...
Should pituitary suppressive medications be stopped prior to radiosurgery for patients with a functioning pituitary adenoma?
The first reported significantly lower hormone normalization rate was in acromegaly patients who were receiving antisecretory medications at the time of radiosurgery. Subsequently, similar finding was reported in prolactinoma patients. The suggested rationale is antisecretory medications alter cell ...
Would you consider APBI using the Florence regimen in patients with preexisting breast implants?
There is data on using other APBI techniques with preexisting implants, ex. interstitial brachytherapy.I have used Florence regimen on patients with implants but counseled they were not included in the study and warn about the risk of capsular contracture.
How would you manage a presumed radiation induced sarcoma of the head and neck?
Surgery and re-irradiation (BID).