Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer definitive radiotherapy for prostate cancer (or another solid organ malignancy) to a patient on maintenance Rituximab for lymphoma?
Good question and a somewhat increasingly common issue in the general sense of patients with overlapping hematologic and prostate malignancies. For starters, I would think hard about the risk group of this patient and competing risks. If this patient has an aggressive or relapsed lymphoma with favor...
Is it ever appropriate to treat just the ipsilateral oropharynx and neck for head and neck cancer of unknown primary?
I usually treat the bilateral neck, because half of the unknown primaries are likely in the base of the tongue, unless there’s a really good reason to reduce toxicity. And there usually isn’t.
In cT4aN0 triple negative breast cancer would you still recommend PMRT if pCR, ypT0N0(sn), after neoadj chemo is achieved?
This case includes several distinct issues. The first is the accuracy of the initial staging. The AJCC 8th edition definition of clinical stage T4a is: "T4a is extension to the chest wall. Adherence/invasion to the pectoralis muscle is NOT extension to the chest wall and is not categorized as T4." E...
How would you treat intermittent hematuria post prostate radiation?
The citation below, good article, and excerpt below, a summary that may answer your question. Our urology colleagues would appreciate it if we initiated a workup like this, but I would always ask the patient to see a urologist as well. HBOT should be considered. “For grade 1 and grade 2 types, sympt...
What rectal spacer do you recommend for prostate cancer patients?
I’ve only ever worked with SpaceOARs. I’d be interested to hear from providers who have gotten to work with both. There are similarities between both. A similar amount of total volume is injected with either procedure. Both products begin natural resorption around 3 months after placement. SpaceOAR ...
When do you recommend induction chemotherapy prior to concurrent chemoradiotherapy for locally advanced NSCLC?
I rarely recommend induction chemotherapy prior to definitive concurrent chemoradiation. This is because two randomized studies, LAMP (PMID 16087941) and CALGB 39801 (PMID 17404369) showed no survival benefit and added toxicity with induction chemotherapy compared to concurrent chemoradiotherapy alo...
What radiation dose would you use to treat a symptomatic osseous lesion secondary to AL-amyloidosis?
Extrapolating from our tracheobronchial experience, we’ve used 20 Gy in 10 fractions to target the underlying plasma cells that produce amyloid production. We’ve also used this regimen for ocular and GU (ureteric and bladder) amyloidosis. If there are obstructive or symptomatic lesions, then surgica...
How long do you wait to start adjuvant radiation after prostatectomy?
Generally, I will wait until the patient has recovered urinary continence before beginning adjuvant RT. In most cases, that will occur by about 3 months, but I have had patients in which I have waited as long as 12 months before beginning adjuvant RT because continence was slow to recover. In cases ...
When using oral contrast for simulation, how much prior to simulation do you have patients drink the contrast?
There are primarily three situations in which I might use oral contrast. The first is when treating an esophageal cancer, in which case we give the patient a small amount of contrast in the simulator and then have them drink some more just seconds before the scan. The second situation is when one wa...
How would you manage a patient with early-stage invasive ductal carcinoma with associated low-grade DCIS who was found to have ADH at the tumor margin on post-op pathology?
Presume it is focal and not diffuse involvement by AFH, I would get pre RT mammogram and if no residual calcification or abnormality, would proceed with RT.