Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach adjuvant treatment in a patient with completely resected undifferentiated pleomorphic sarcoma of the chest wall that recurred after 2 years, initially treated with neoadjuvant radiation and resection?
There is no evidence to support adjuvant treatment after re-resection. In the case of recurrence, we prefer to biopsy the mass to prove recurrence and obtain tissue (for NGS). In the case of recurrence, if we were to give systemic therapy, then we would favor neoadjuvant chemotherapy- provided this ...
What is the role of EBRT/brachytherapy (as an addition to chemotherapy) in the adjuvant management of optimally debulked stage IV uterine serous carcinoma?
There is no prospective study in this setting and based on limited retrospective data we do consider adjuvant RT for optimally debulked (meaning no macroscopic disease left behind after surgery) disease. We do consider pre surgery bulk of disease in decision making and would recommend RT for those w...
Can radiation therapy alone for localized recurrence of high-grade B-cell lymphoma be considered for those that previously received rituximab-based chemotherapy?
High-grade B-cell lymphomas are distinct entities no longer classified as "diffuse large B-cell lymphoma" by the WHO. They include: High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (often referred to as double hit or triple hit lymphoma). High-grade B-cell lymphoma, NOS (thes...
How does prior prostate artery embolization impact your treatment recommendations for prostate cancer?
PAE is a "newer" modality that is being used to treat LUTS in men with BPH and BPH symptoms at baseline. Case series report relatively impressive results, with the average AUA score dropping from around 20 to 8 in populations receiving this therapy. PAE is sold as a procedure that is unlikely to hav...
How do you respond to a patient who asks "Why do I still need breast radiation after chemotherapy if chemotherapy treats the whole body?"
Perhaps one of the best arguments supporting RT in breast cancer is the not-that-often cited Scottish Trial that randomized women to postoperative RT or chemotherapy following breast conservation; the breast failure rate following adjuvant chemotherapy alone approximated 30% with short follow-up. Ob...
What adjuvant treatment would you offer a patient who underwent cystoprostatectomy for a muscle invasive bladder cancer and discovered to also have prostate cancer?
Complex case. If they have an indication for prostate RT (major: positive LN, persistent PSA, +SVI, minor: + margins, +ECE), I would consider treating the prostate fossa +/- LNs. As far as the bladder, we don't have the answer yet, but high-risk patients are being studied on the BART study from Tata...
What methods do you use to prophylactically reduce radiation dermatitis for head and neck irradiation?
My approach has been: Start Remedy (less greasy but less effective) and/or Aquaphor (more greasy but more effective) 3-4x daily at beginning of RT. Try to use Aquaphor at least at night when the greasiness is less bothersome. If patients have some other alcohol-free/non-anti-oxidant product they re...
When treating bladder cancer with 55 Gy in 20 fractions, what small bowel dose constraints do people use?
Yes, it is hard to tell what happened on that trial because we don't know how often small bowel might have been excluded from the PTV. It would be nice to hear from others, like @Dr. First Last. And maybe theMednet can get Dr. James to join? For what it is worth, when this is an issue, I treat with...
In what circumstances would you offer adjuvant radiation after resection of vulvar mucosal melanoma?
If immunotherapy is indicated, I would start that right away. I would treat for positive margins or melanoma in situ at the margins using 30/5-6 fx twice a week. Would treat the tumor bed with a 10-15mm margin. I wouldn't treat the groins. Would also recommend a thorough GYN exam in the OR if not d...
Is it appropriate to use photon energies above 15 MV for prostate SBRT?
We have abandoned energies of 15MV or greater in our entire clinical enterprise. We do so much IMRT that the risk of neutron production with higher energies is not worth it. Furthermore, multi field IMRT or SBRT eliminate the need for the high energies. Our standard machine configuration is 6MV & 10...