Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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).
What bowel constraints do you use when treating definitive bladder?
I often find a V60<10 cc bowel constraint too restrictive and challenging to meet without significant compromise of tumor coverage due to the aforementioned tendency of the bowel to sit atop the bladder dome, and requisite standard PTV margins.First and foremost, I obtain daily CBCT for these patien...
How would you treat patients with advanced head and neck cancer with involvement of upper mediastinal lymph nodes?
Depends on the extent and condition of the patient. For a healthy patient, limited upper mediastinum, I’d treat aggressively with chemoRT.
How do you manage grade 3 dermatitis during chemoradiation therapy for anal cancer?
This is a great question for this forum because management of skin toxicity is so dependent on personal and local experience. I’m interested to see what others have to say!At baseline: apply lotion such as radiaplex or aquaphor to skin, keep area clean, limit skin chafing by wearing loose fitting cl...
What is the optimal dose and fractionation of RT for a T2N0 laryngeal SCC?
Great question. The data for accelerated fractionation (AFX) vs. hyperfractionation (HFX) vs. standard fractionation for T2 is a bit difficult to parse.At a basic level, we all recognize that T2 larynx spans a range from pts just a bit larger than T1 TVC cases, who could expect >90% survival with RT...
How much subglottic extension from a primary glottic tumor would make you treat the regional lymph nodes?
This is a question that may be more complicated than it looks, though I recognize that Dr. @Dr. First Last has a wealth of experience in this area. The first issue is that the definition of the cranial extent of the subglottic region is not standardized. It can vary from just under the cord to 5 mm ...