Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer adjuvant radiotherapy for a gross totally resected WHO grade 2 hemangiopericytoma/MFT of the brain in a patient with active multiple sclerosis?
This is a tough question to answer, as there are risks associated with either recommending post-operative radiotherapy or not. Hemangiopericytomas are rare intracranial tumors that arise from pericytes, support cells found in the wall of meningeal capillaries. They are part of a larger spectrum of m...
What are the indications for adjuvant RT following resection for intracranial hemangiocytomas?
Hemangiopericytomas (HPC) are rare and challenging tumors affecting mostly the brain.The primary approach is a safe complete resection (GTR) but this is not always feasible as in the case in question. HPC is considered part of a spectrum with solitary fibrous tumor (SFT), with HPC representing a mor...
How do you approach the management of an early stage non-small cell lung cancer limited to an endobronchial location (non-obstructing) in a patient that is not considered operable due to medical comorbidities?
The use of SBRT is predicated on CT based imaging so that a physical and visible target can be delineated and for which a radiotherapy plan can be generated. For patients where no such imaging-definable lesion has been identified, as with for example, an endobronchial-only lesion noted at the time o...
For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?
This is a common clinical question that has been repeatedly explored in meta-analyses and clinical guidelines. Consistently, there's no evidence to support primary prophylaxis for seizures in patients with brain tumors including brain metastases. In summary, the data does not support the routine use...
For external-beam partial breast irradiation, if the CTV lies close to the skin surface, do you apply bolus?
We do sometimes use bolus if the skin surface is within 1 cm of surgical cavity and also make sure when planning there is flash created to account for inter fraction and intrafraction motion.
Do you wait until a ureteral stent is placed to plan a locally advanced cervical cancer with hydronephrosis?
The simple answer is YES. We typically wait for ureteral stent placement before we start the radiation treatment planning process because of many potential benefits to the patient such as improving the patient's renal function status so she would better tolerate the full dose of cisplatin chemothera...
Do you have different hotspot and heterogeneity goals for SBRT of ground glass lesions vs more solid adenocarcinoma NSCLC lesions?
I would base my hot-spot goals more on lesion location and geometry than on appearance or other clinical factors.For a purely peripheral lesion, the planning focus is on conformality, and with an FFF beam allowing a high central hot spot by asking the planning algorithm to focus only on rapid fall-o...
Which patients with rectal cancer who have not received neoadjuvant treatment do you offer adjuvant radiation to?
In order to answer this question, we may need to step back and first review the indications for radiation treatment in the neoadjuvant setting.Neoadjuvant concurrent chemoradiation or short course radiation treatment is considered to be part of the standard treatment (recommended by guidelines) for ...
Do you administer prophylactic antibiotics for GU procedures?
The common GU procedures performed in radiation oncology are transperineal brachytherapy and transperineal retroprostatic hydrogel insertion. Rarely transrectal biopsy or transrectal intraprostatic injections may be performed by radiation oncologists. I don't believe any randomized studies looking a...
Is there a PSA value below which you would not offer salvage radiation post-prostatectomy?
I am commonly asked the inverse question: if I use a "PSA cutoff" whereby a rise beyond this value will strongly favor treatment with post-op radiation. I think it is difficult to have a set value that applies for all patients, as the decision to treat should be individualized to patient and disease...