Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage a cytology-negative pleural effusion that develops after lung RT?
I think most times you can just watch them as long as they are stable and not symptomatic. I see them not infrequently after RT, especially lung SBRT, and find they often find a size they feel comfortable with and don't change much over time. I wonder about their physiology... my impression is there...
How do you manage a nodal recurrence of an early stage glottic laryngeal cancer previously treated with definitive radiotherapy?
As a general rule, patients with post-RT recurrences that are resectable should undergo surgery rather than re-irradiation, unless surgery is expected to be associated with substantial risk or functional deficit (in which case the patient should be consulted about the risks of each modality). In the...
How do you counsel eligible patients on lung cancer screening who are hesitant because of the cancer risk from CT scans?
This is simple. The risk of lung cancer in patients who have smoked for >20 years is orders of magnitude higher than the theoretical risk of medical X-ray-induced cancers from low-dose CT (LDCT) screening. A typical LDCT scan exposes patients to approximately 1.5 mSv of radiation, equivalent to abou...
What is your radiotherapy plan for stage IVA (cT4) cervical SCC with the tumor completely obliterating the bladder trigone?
I would follow the same schedule. After concurrent chemo RT, I would use HDR brachy with a hybrid applicator to achieve a D90 of 85 Gy or above to the HR-CTV and avoid any hotspot in the bladder wall. Part of the bladder wall in the trigone area receives a therapeutic dose.
Are there any trials currently studying low-dose RT for confirmed COVID-19 infections with associated pneumonia?
This is a joint reply from a team developing a prospective trial to answer this question:Minesh Mehta, Arnab Chakravarti, Walter Curran Jr, James Fontanesi, Vinai Gondi, Michael Kasper, Deepak Khuntia, Rupesh Kotecha, Ramesh Rengan, Leland Rogers, Charles B. Simone II, James Welsh, George WilsonThis...
Is it safe to deliver definitive radiation for a solid tumor malignancy (ie H&N) concurrently with maintenance lenalidomide/Revlimid for multiple myeloma?
The combination should be adequately tolerated, assuming that the patient is otherwise of good KPS at baseline without significant risk factors. The caveat here is that data on concurrent RT and novel thalidomide analogs (lenalidomide) is largely limited to retrospective reviews, singular case repor...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
Are you altering your use of Active Breathing Coordination for breath hold technique patients in light of the COVID-19 pandemic?
We use DIBH, and this has not changed anything in our practice.
In a patient with pancreatic carcinoid s/p resection with positive margins do you recommend surveillance or adjuvant therapy?
Well-diff and by small size (<1 cm), NCCN guidelines would have said watch this from the start, so certainly wouldn't recommend any adjuvant therapy at this time for positive margin resection. Margin status has been shown not to be associated with overall survival outcomes, particularly for low-grad...
Do you base liver SBRT dose fractionation on size, volume, or proximity of normal tissue?
I think about this differently than most people do. My goal is to deliver an ablative dose (100 Gy BED) regardless of the proximity of organs at risk or the size of the tumor. The more common thing to do is to reduce the dose of radiation below an ablative dose to 40 or 30 Gy in 5 fractions. I'm not...