Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the maximum time you would allow between simulation/treatment planning MRI and delivered treatment for stereotactic radiosurgery for brain metastases?
All efforts should be taken to have the patient treated as early as possible after simulation. If a delay is inevitable, up to 7 days is acceptable in most situations. However, for patients with melanoma, due to risk of hemorrhage and potential aggressive progression, the delay should be shorter. Pa...
Would you ever omit adjuvant radiation for a patient with rectal cancer originally staged cT1N0, but found to be pT1N1 after surgery?
Certainly a topic that comes up not uncommonly in tumor boards. The gold standard comparing pre to post operative chemoradiation remains the German colorectal trial, and showed increase in acute diarrhea from 12% to 18% and long term GI sx from 9% to 15%, strictures from 4% to 12%. Although there is...
In which patients do you omit a boost following whole breast irradiation?
In a woman over 60 with a T1 or T2, low to intermediate grade tumor resected with clean margins (preferably greater than or equal to 2 mm), I think it is very reasonable to omit a boost. I tend to take these on a case by case basis. If I can deliver a boost with a small field (for example 8 cm or le...
Would you offer PMRT to a young patient with a remote history of mantle/lung RT for Hodgkins lymphoma and a left cT0N1 triple positive breast cancer with a complete response after neoadjuvant chemotherapy?
I would favor adjuvant RT in this situation. Given up front bulky and multiple nodes, even though she had pathologic complete response. I would cover chest wall, axilla, and SCV fossa and consider IMNs based on cardiac and pulmonary doses.
Do you change your definitive therapy approach for a patient with locally advanced central NSCLC with obstruction of a mainstream bronchus and subsequent collapse of the lung?
Treating a patient with a collapsed lung with definitive CRT can be difficult. Those patients typically have a higher risk of infection and often have increases in the rates of symptomatic pneumonitis. My first priority is to try to get the lung open before initiating definitive treatment. Often, in...
Why is it recommended that patients not apply moisturizer in the radiation field immediately prior to daily treatment?
The received wisdom of Radiation Oncology that patients should not apply topical agents before radiation treatment was promulgated out of concern that said topical agents would act as "bolus" of sorts, and increase the radiation dose to the skin in a way that would enhance radiation dermatitis. For ...
How do you counsel patients on sun exposure during radiation?
I tell them to avoid sun exposure as much as possible if in the area(s) that need to be radiated. Beyond standard recommendations about the sun and the risks that should be part of their normal MD (GP) or dermatologist conversations, we can cause skin reactions with RT and it is important to have as...
Do you recommend self-breast exams to your patients with history of breast cancer in addition to imaging surveillance?
This is a somewhat controversial question. I cannot find any data on the risks or benefits of counseling on self-exams in breast cancer survivors. I will simply say this. Among survivors, there are differences between patients that I think the physician must understand and meet the patients where th...
How do you treat a high grade prostate cancer with bulky direct bladder invasion?
Interesting to see a treatment paradigm presented where an insurer would fathom A) protons and B) fluciclovine for staging, and C) second generation anti-androgen on top of LHRha to treat a locally advanced, non metastatic prostate cancer. I agree that there is the possibility that some of these thi...
What is a safe and effective dose and fractionation for palliating head and neck cancer?
I agree with aggressive treatment in patients with a good performance status. For those with a poor PS or with multiple comorbidities, we've used the QUAD SHOT regimen- 14Gy over 4 fractions in 2 days, repeated every 4 weeks up to a dose of 42Gy/12 fractions, if tolerated. This fractionation gives a...