Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend MRI post surgery and pre-irradiation for patients with extensive DCIS and close margins and how would it impact your management?
MRI post-op may be hard to interpret. Favor mammogram especially if had microcalcifications pre-surgery, it makes sure they are all removed.
Does location of an non-spinal osseous metastasis affect your SBRT dosing?
Just a few thoughts: Location is an important consideration for SBRT dosing because normal tissue tolerances vary by organ/location. Three complications that I worry about are the risk of bone fracture, neuropathy and myositis when treating non spinal osseous mets with SBRT, especially in the settin...
For AYA patients with early-stage Hodgkin's lymphoma being treated with ABVD, how many cycles of chemotherapy do you administer, and when can radiation be avoided?
It depends - favorable/unfavorable, distribution of disease, co-morbidities, gender, family history, etc. I don't treat pediatric patients, so the comment below applies strictly to young adults.If a patient has early-stage, favorable HL per GHSG criteria (no risk factors), then 2 cycles of ABVD + 20...
For patients receiving TNT for locally advanced rectal cancer who have received chemotherapy prior to chemoradiotherapy, do you treat the pre or post-chemotherapy volume for the boost, especially in patients who have had a near complete response?
I base my boost volume upon the pre-chemotherapy extent of gross disease. Times I have selectively deviated from this are almost exclusively related to unfavorable normal tissue anatomy (i.e., significant volume small bowel deep in the pelvis) such that covering the initial extent in the boost volum...
How do you counsel patients receiving head and neck radiation regarding its impact on both existing and future dental work?
We send any patient who is having any portion of the maxilla or mandible to their primary dentist for an evaluation. If there is anything other than a simple restoration, we refer patient to a set of oral surgeons we work with for evaluation. They ensure any pre XRT dental root work is completed and...
Do you recommend prophylactic hyperbaric oxygen for patients who require tooth extraction after head and neck radiation?
The benefit of prophylactic HBO before extraction in HNC was determined in a single randomized study from 1985 (Marx RE et al), where pts received 2D RT, likely delivering the full tumor dose to the posterior mandible. However, using IMRT sparing the non-involved mandible (and producing a dose gradi...
Is there a threshold dose to the mandible above which you consider prophylactic HBO prior to dental extractions that are required after RT?
We do not consider HBO before extraction from parts of the mandible that had received high doses. If ORN happens, we would refer the patients to surgical debridement of the affected area if it does not heal spontaneously. Our experience is that strict prophylactic dental care, as well as IMRT aiming...
Is there a threshold absolute neutrophil count for which you would consider holding radiation?
I don't have a threshold dose for holding radiation. This decision is based on the etiology of the leukopenia. If the patient is receiving concurrent chemoradiotherapy it is usually the chemotherapy causing the issue and I rarely hold radiation even with ANC < 1000. If one were to hold both the chem...
Would you offer any adjuvant therapy for a young patient with anal cancer s/p definitive chemoradiation and R0 resection with significant residual disease?
We do not have complete details regarding the clinical history of this case. For instance, information about the patient’s initial response to chemoradiation—whether residual disease was identified early or if this represents a local recurrence after an initial favorable response—would be important ...
What is the optimal schedule for fractionated SRS treatment of CNS tumors?
I don't think there is one ideal dose/fraction schedule. Doses should be individualized for your institution, including factors such as immobilization, set up, and margins. There are published data on ranges of SRT.For larger tumors, typically defined as 2 cm to up to 3-4 cm I would favor 24-27 Gy i...