Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage leptomeningeal disease of the spine in the setting of prior WBRT?
This is an extremely challenging clinical situation. The decision points depend on treatment goals: If the goal is local palliation, simply treat local areas of disease, e.g. spinal segments. If effective systemic therapeutic options are available, obviously consider those first, including intrathe...
Can tacrolimus in a transplant patient be used during radiation and concurrent chemoradiation?
Patients with solid organ transplants present unique challenges in management and risk of infectious complications, among others. The short answer is that tacrolimus can be used in the lowest dose possible, along with concurrent chemoradiation and close coordination with the transplant team. If the ...
Are there special considerations when treating a patient with sarcomatoid SCC of the head and neck?
Sarcomatoid HNSCC is generally considered a less uncommon but more aggressive version of conventional HNSCC, thought to be at least in part arise as de-differentiated high-grade SCC. While they have been reported in some small studies to arise within a previously irradiated region, these epithelial ...
Do you treat retroperitoneal sarcomas with a boost to the rind (or suspected close surgical margin)?
I have done this for retroperitoneal sarcomas that have contact with structures that represent challenges for my surgical colleagues (e.g. vessels, spine). This was initially inspired by the publication by the group from UAB who delivered 45 Gy in 25 fractions to the whole target and then boosted th...
What hypofractionated radiotherapy dose regimen is acceptable for plasmacytoma?
At the end of the day, it all comes down to delivering a reasonable BED in the range of +/- 50 Gy in fractions of 2 Gy. The type of fractionation chosen is a question of the treatment volume, location, and adjacent OARs. I have treated a few plasmacytomas with SBRT (for instance in the ribs) with 3-...
When do you feel it is safe to initiate palliative radiation therapy to the bone (spine, femur, humerus, etc.) following surgical fixation with hardware (with or without cement) without compromising the stability of the hardware?
It depends on the patient and clinical urgency to initiate radiation to bone following surgical fixation. Usually 2-4 weeks, 2 weeks is the earliest as long as patient’s pain is controlled post surgery and skin/incision is intact and healed. I usually start 3-4 weeks if radiation is not urgent just ...
How do you treat multi-focal/diffuse non-melanomatous skin cancers of the face and scalp for which you would also want to cover high-risk elective nodes?
Skin cancer in elderly individuals is frequently multifocal and episodic in its occurrence. The cancer inducing damage to the skin took place over an extended period of time many years prior to the development of these lesions. The appearance of new skin lesions is often episodic with one or more le...
Do you utilize genetic testing to guide ADT for men receiving XRT for intermediate or high risk prostate cancer?
This question is currently the subject of an NRG Oncology trial (https://clinicaltrials.gov/ct2/show/NCT05050084) and I would encourage participation so that we can get a data-driven answer to this important question as soon as possible. Outside of the context of a trial, I do not currently use gene...
What is your approach to a patient with locally advanced cervical cancer who presents with a fistula (rectal or bladder)?
For bladder fistula, we usually get a bilateral nephrostomy done for diversion and then treat patients with definitive intent with chemo RT with brachy using an interstitial device. We reassess the patient with PET/CT in 3 months and if complete responses, then they get urinary diversion with ideal ...
How do you manage a patient's pain from the skin tattoos placed at the CT simulation?
The best way to avoid pain from tattooing patients is to stop tattooing patients. In the modern era, many clinics are moving away from tattoos. SGRT has allowed a "tattoo-less" setup. That being said, if tattoos are still used, the pain is transient/self-limiting. I've never heard of chronic pain is...