Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage a bladder cancer patient who had a partial cystectomy with a positive margin?
In fewer than 5% of bladder cancer patients, partial cystectomy along with neoadjuvant cisplatin-based chemotherapy can be considered for stage II (cT2, N0) disease with a single tumor in a suitable location and no presence of carcinoma in situ, where an adequate margin of soft tissue and an adequat...
How would you plan sequencing of an MRI-directed prostate nodule micro-boost when doing a sequential plan?
Some reports do profile the use of a sequential tumor boost (e.g., Miralbell et al., PMID 19910135); however, I would usually not recommend this unless a brachytherapy boost is planned. Although I could think of a few niche circumstances where there could be a rationale for a sequential boost (SEQ),...
In a patient with cardiac comorbidities, who meets ASTRO APBI criteria other than a positive margin, would you offer APBI in an attempt to reduce cardiac dose?
There are still substantial uncertainties about the impact of specific risk factors on the local recurrence rate following PBI. A tumor-free margin width of less than 2 mm was associated with a high risk of local failure in a number of studies (Chen et al., PMID 16421922; Vicini et al., PMID 1730693...
How would you manage dysphagia and odynophagia in an otherwise healthy patient with newly diagnosed metastatic esophageal cancer with a large primary in the mid to distal esophagus?
Depending on patient goals of care, in an otherwise healthy patient starting with chemo to address both the esophageal cancer causing dysphagia as well as the systemic disease is also our preferred plan as well, with analgesics as needed for the odynophagia. Along with dietary modifications perhaps ...
When using conventionally fractionated breast RT, does one need to treat the whole breast to 50Gy or is 45Gy, followed by a boost satisfactory?
One of the reasons why hypofractionation schedule appears to have less acute and late morbidity in comparison to 50 Gy is because of lower equivalent total dose ( about 46 Gy equivalence). Besides the data is mostly on central axis dose homogeneity rather than 3D dose homogeneity and for that reason...
Would you treat the whole bladder with a cervical cancer that is invading the bladder?
The short answer is no. The posterior wall of the bladder is generally what will be involved and will be in the PTV anyway. This is how I would approach planning: I would fuse the MR T2 sequence with my planning CT, and use the cystoscopy report as well to ensure that the involved portion of the bl...
How long of a delay are you willing to accept for vaginal cuff brachytherapy either as primary therapy or as boost?
The absolute benefit of vaginal cuff HDR boost is small and 6 months delay would negate any such benefit.
What is your approach to a patient with prostate cancer with suspicion of rectal wall invasion but otherwise localized disease?
My approach in a prostate cancer patient with "suspicious" rectal involvement is to verify, in fact, if he has actual rectal involvement, or not and NOT "suspicious" involvement. I guess my point is that I WOULD BE VERY hesitant to start RT intervention without verifying if the patient had rectal in...
Does a negative staging PSMA PET in a patient with biopsy-proven recurrent prostatic adenocarcinoma change your management?
The bottom line is that you have to believe the biopsy. PSMA PET will not show microscopic disease, which is why it cannot "rule out" disease in lymph nodes or elsewhere. It is comforting when it is negative, but it is not absolute truth. A few questions; What was the PSA at the time of the PSMA PET...
Is it safe to give thoracic irradiation to a patient with lung cancer previously treated with a VEGF inhibitor?
We did a study in patients getting VEGF inhibitors and SBRT. Anecdotally we had seen some impressive (small bowel necrosis requiring surgery) and unpredicted toxicity and we were looking for a common factor that tied them together. VEGF inhibition was that common factor. These are all patients treat...