Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient diagnosed with squamous carcinoma involving the entire length of the vagina and extends into the vulva (introitus), who has severe vaginal stenosis?
If this is a vaginal lesion involving the vulva, it should be classified as vulva cancer and treated like so. Typically with ext beam boost to 66 to 70 Gy.
What bladder constraints do you use for prostate cancer patients who have a completely empty bladder?
There are some situations where there really is no urine in the bladder for which empty bladder constraints are needed. However, the vast majority of the time empty bladder is due to incontinence after prostatectomy. This is an especially important situation since a portion of the bladder is in the ...
How would you palliate a metastatic lesion abutting a joint with an associated effusion?
I don't know that there is data for this - not that I could find. Bone metastases themselves cause pain due to multiple factors - mass effect, inflammation, and microenvironment changes. I'd guess the effusion is potentially due to the existence of the metastases (an inflammatory reaction), rather t...
Do you use any thyroid dose constraints for head neck radiation planning?
I do not constrain the thyroid. Careful monitoring post-operatively for hypothyroidism and appropriate thyroid replacement is reasonable. There is another, more theoretical concern that I have in that based on a Childhood Cancer Survivor Study Analysis, intermediate RT doses to the thyroid (10 - 30 ...
What dose would you use to treat unresectable basal cell carcinoma of the vulva?
I have treated one patient with 55 Gy in 20 Fx who is NED at 3 years post-RT. Had some acute RT toxicities similar to most vulvar cancers. Treated gross disease alone with small margin, as mentioned above.
Will you treat brain mets with SRS in patients who cannot undergo MRI?
I agree with all of the previous comments. In addition, I'd like to add my own anecdotal experience. I saw a patient with widely metastatic melanoma who underwent head CT instead of an MRI brain due to the presence of pacemaker. There was a nodular enhancing focus read as suspicious for metastasis, ...
How would you approach treatment failures with squamous cell carcinoma-keratoacanthoma-type lesions that did not respond to a standard SRT regimen after many sessions?
Most keratoacanthoma-type cutaneous squamous cell carcinomas that I see are bulky, and superficial radiotherapy (SRT) would not provide an adequate depth of radiation penetration to eliminate the carcinoma cells. If radiotherapy is being used for a bulky tumor like this, a higher energy form of more...
In patients with early-stage follicular lymphoma undergoing definitive RT, do you approach grade 3a disease any differently than grade 1-2 (radiation dose, fields/margins, systemic therapy)?
Our philosophy is based on whether it is grade 3A or 3B. If it is 3A, then we treat like low grade lymphoma with RT (similar dose and principle) but if it is 3B, then treat with chemotherapy +/_ RT like diffuse large B cell lymphoma.
Is there evidence to support or argue against intermittent fasting for cancer patients?
This is a complex topic with many permutations of dietary interventions similar to fasting such as calorie restriction and “fasting mimicking”, but as it pertains to pure fasting, I know of a few small studies which characterize fasting around the time of chemotherapy infusions (Raffaghello et al., ...
Would you boost a resected axilla if extra-nodal extension is found in a patient with breast cancer?
The data on ECE for breast suggests it increases the risk of recurrence in undissected axilla or supraclav region. We don’t boost ECE region and most of the time don’t even include the dissected axilla with ECE in treatment volume unless the dissection is inadequate.