Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is SBRT feasible to a renal cell carcinoma at the renal hilum?
SBRT can be safely delivered to the renal hilum and collecting system. This has been published. This is important because thermal ablation is contraindicated if the tumor is near and involves the hilum. There is also experience of using SBRT to the the ureter.
For cases of foraminal and extraforaminal monophasic synovial sarcoma post excision with note of residual tumor, would your approach be a second look surgery with re-excision or delivery of adjuvant RT with boost to residual disease?
Great (and tough!) question. In the setting of residual disease post-surgery, many studies have shown that even with adjuvant radiation therapy, leaving gross disease behind leads to inferior outcomes. In the setting on non-oncologically excised tumors, I would first have a discussion with the surg...
Does the path length of vaginal cuff cylinder brachytherapy treatment as adjuvant therapy for endometrial cancer vary based on histology (serous, etc)?
There was some thought that treatment of high risk histologies, positive LVI, or high Grade required a longer vaginal length be treated. Including 2/3 or full length. That is largely unsupported by high-quality data and would increase distal vagina toxicity in this population. Our clinic treats uppe...
Is DCISionRT appropriate for multifocal DCIS?
Decision RT principles can be applied to multi-focal DCIS also.
Would you offer salvage radiation in a patient s/p radical prostatectomy with imaging showing local recurrence as well as oligometastatic disease in the pelvis?
For oligonodal regional recurrence, I would treat the entire pelvic nodes and fossa and consider enrollment on RTOG 3506. If oligomet is to pelvic bone, I have rarely treated fossa/nodes/pelvic bone lesion (PET identified) in those wanting to be very aggressive and understanding the lack of data the...
How would you manage a patient with de novo oligometastatic anal cancer with a single metastasis in the pubic bone?
I am not aware of much data to guide decision-making in a situation like this. For this patient, where imaging shows no other evidence of metastatic disease, I favor treating with chemoradiation with an SIB to the area of bone involvement, trying to deliver the same dose to the metastasis as the pri...
Would you recommend post op radiation therapy for a primary pulmonary synovial sarcoma which underwent lobectomy?
Preop RT would have been worth considering, but I don't see a role for postop RT in the thorax given negative margins and the extent of the field that would be required. It is unclear why neoadjuvant chemo was not considered for a large high grade tumor, but would at least ensure the patient sees me...
What dose constraints do you use when treating gastric MALT or DLBCL with radiation therapy?
Treatment of the entire stomach is recommended for gastric MALT lymphoma. A dose of 24-30 Gy is recommended, generally in 1.5 Gy fractions to limit acute toxicity. I am starting to utilize 24 Gy more frequently though, most studies have used 30 Gy. Gastric MALT tends to be multifocal, is not well vi...
How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?
I subscribe to the philosophy of "hitting hard, tapering slowly" for cases of pneumonitis, either radiation pneumonitis, or checkpoint inhibitor-related pneumonitis (some of those cases probably have mixed origin, with contributions from radiation and/or checkpoint inhibitors). For severely symptoma...
How do you manage squamous cell carcinoma in situ of the anus?
The first question I always ask when I get a case of in-situ squamous cancer is it reallly in-situ? If the physical examination suggests an invasive cancer or if the visible disease is very superficial but extensive, then it may be a sampling error and a few more biopsies are indicated.Assuming that...