Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat an isolated port recurrence of an early stage cervical patient s/p WLE?
In limited cases we have managed this with surgery and chemoRT as definitive treatment
Would you use different EBRT field edge for an HIV positive patient with FIGO IIIC1 (2018) cervical cancer with positive bilateral external iliac nodes?
In any situation I would not favor bony landmark and use anatomical vascular landmarks. This is a review article in Seminars in Radiation Oncology summarizing nodal RT for cervical ca written with North American and European collaboration.
Do you continue Megestrol in a patient with inoperable endometrial cancer during definitive radiation therapy?
I usually stop megace as definitive RT takes care of bleeding and disease . This also reduces risk of megace induced side effects
How would you approach an inoperable, elderly, frail patient with high risk endometrial cancer?
May be less toxic, unless patient is "inoperable" because of high anesthesia risks, making endometrial brachy risky.
How does the presence of microcystic elongated and fragmented (MELF) invasion impact post operative treatment of Stage IA FIGO grade 1 endometrial cancer?
MELF pattern may be associated with under-assessment of LVSI. In the setting of surgical assessment of nodes, we don’t change treatment recommendations just based on MELF pattern.
What is your treatment approach for an adenoma malignum of the cervix?
Data for this rare entity is mixed but for now, treat with the same philosophy as other histology with chemo RT.
Do you have cut off values for neutrophil and platelet counts when doing interstitial brachytherapy for cervical cancer?
For template-based interstitial brachytherapy, I (and my anesthesia colleagues placing the patient's epidural) require platelets > 100. I suppose for a hybrid one, could consider at 50-100 but I would still prefer > 100. > 50 is my personal threshold for ICBT alone. ANC thresholds - I'm generally ha...
How do you treat a locally advanced cervix cancer in a patient who declines brachytherapy?
You provide this lady with a curable disease the appropriate social support, mental health support, and transportation coordination in order for her to complete curative treatment with brachytherapy. Anything short of that in America with all our incredible resources and care options is substandard ...
What clinical and pathological factors guide your decision making when considering whether to recommend vaginal cuff brachytherapy following TAH/BSO for a FIGO stage IA or IB endometrial carcinoma?
The most important risk factors for vaginal wall recurrence for endometrioid adenocarcinomas are grade, depth of invasion and presence of lymphovascular invasion. Now that stage IA includes endometrium only and up to 50% myometrial invasion, it is important to consider the other risk factors. I usua...
How would you treat a patient with a FIGO G1 pT1bN0 endometrial adenoCA involving the lower uterine segment with >50% invasion and a separate focus of disease found involving the endocervical mucosa with no cervical stromal invasion?
Brachy alone as mucosal involvement would not change my management.