Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a pre-menopausal female with cervical cancer, would you boost a hypermetabolic ovary on PET?
Hypermetabolic ovary is very common and physiologic in premenopausal women and I would not boost that area. MRI pelvis can confirm benign nature of this uptake
What clinical factors would lead to utilizing a tandem and cylinder rather than tandem and ovoid for cervical cancer brachytherapy?
Tandem and cylinder should be used with caution as it is hard to cover the entire cervix and paracervical region with tandem and cylinder. If the patient has lower vaginal disease with good response to chemo RT, one can use tandem and cylinder but may need some needles to cover entire cervix.
What is your institutional protocol for an incidental finding of an adnexal cyst on CT simulation for cervical cancer?
It is not common to have this finding. A combination of PET CT and MRI confirms the benign etiology of these cysts and can be ignored for cervical cancer management.
Would the presence of multifocal LVSI change your adjuvant treatment recommendation for a surgically staged IA dedifferentiated endometrial carcinoma?
Dedifferentiated is considered a high-grade lesion. There is admittedly low quality evidence on optimal management given lower incidence.I would recommend treatment with vaginal brachytherapy and very much offer chemotherapy. Would prefer vaginal brachytherapy, given the patient was surgically stage...
How does number of ITC influence your approach to adjuvant RT for a surgically staged 1B endometrial cancer meeting HIR criteria?
Management of ITC only in the setting of SNLN is not defined well. We know ITC has a much better prognosis than micromets and macromets. We also know that even with ITC after SNLN bx only, there is risk of additional residual nodal disease left behind which may need to be addressed. What we don’t k...
Would you offer consolidative radiation for oligometastatic uterine serous CA s/p surgery and chemotherapy with complete response?
Usually not unless pelvis only confined disease at presentation or microscopic omental disease removed at surgery.
What are indications to add WPRT +/- PA field to chemotherapy for uterine serous carcinoma?
There is variation in practice. After adequate surgical staging, our approach: Stage 1A brachytherapy alone. Stage IB and above, EBRT. If node negative, treat pelvic including entire common iliac. If pelvis node positive and PA node dissected same as above, up to common iliac. If pelvis is posit...
What type of DVT/PE prophylaxis do you employ for an outpatient cervical brachytherapy?
We don’t use anything for outpatient HDR ICBT for cervical cancer.
How would you treat an isolated para-aortic lymph node endometrial cancer recurrence following a prolonged disease free interval previously treated with surgery, chemotherapy, and radiation therapy, if it is located outside of the previously irradiated field?
If no biopsy is done then surgery followed by adjuvant chemo and RT. If bx proven then based on nodal location and size, could be surgery and chemo RT or chemoRT without surgery.
How would you treat a woman who has had a simple, extrafascial hysterectomy for a clinically occult, pathologically FIGO stage IB1 cervical cancer?
Standard would be to do some form of radical hysterectomy and if not done add adjuvant RT. That being said, the absolute risk of parametrial involvement for that size of disease is very low, and the benefit of RT if at all, is very small and requires a discussion of the pros and cons of intervention...