Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of radiation therapy for an elderly patient with medullary thyroid cancer who is not a surgical candidate?
We have offered definitive RT for MTC patients who are medically or surgically unresectable. Dosing is variable based on involved structures, performance status, staging, etc. We have used 5400 cGy in 18 fractions, particularly for the more elderly, poor performance status patients. Coverage of elec...
What is the appropriate dose/fractionation when treating a dermatofibrosarcoma protuberans of the spine following debulking surgery in a patient with a good performance status?
Certainly, a challenging circumstance. With DFSP, pathology review is critical to evaluate for transformation to more aggressive variants with higher malignant potential. Clinically, DFSP is usually present for decades and extremely slow growing. Sudden changes in growth rate are concerning for tran...
What options do you have when a patient has urinary obstruction during radiation treatment?
Here is my general practice on urinary symptom management for a man with prostate cancer undergoing RT.Urinary symptom management RT can decrease urinary symptoms in men with irritable urinary symptoms (http://www.ncbi.nlm.nih.gov/pubmed/20643513) - not sure of mechanism but it takes time to see th...
How do you define your post-operative treatment volumes for a patient with a resected high-grade soft tissue sarcoma of the soft tissues of the upper back?
Thank you for this question. My concern with the lack of pre-surgical imaging is that there is not a good delineation of tumor extent. In scenarios of non-oncologic resection or resection without prior imaging, one should be wary of this. As such, my recommendation would be to be more generous with ...
Can venetoclax and radiation be safely given concurrently?
There is a recent retrospective review by Ho et al which looked at the toxicity profiles associated with "novel" oral lymphoma agents of ibrutinib, venetoclax, and lenalidomide concurrent with radiation treatment for lymphoma, as compared to sequential therapy of novel agent followed by RT (separate...
What dose do you use for single fraction SBRT when treating a small, peripheral early stage NSCLC?
There have been two randomized phase II studies of single fraction versus multi-fraction lung SBRT for medically inoperable early stage lung cancer patients. In RTOG 0915, 82% of patients were T1. In the Roswell Park Cancer Institute study, 86% of patients were stage IA. With that in mind, the curre...
For vaginal cylinder HDR in the setting of adjuvant endometrial cancer radiation, do you routinely alter the prescription dose based on the diameter of the cylinder?
The prescription dose will remain the same regardless of the size of the cylinder that is used and should be specified to the vaginal surface (often 6 Gy x 5) or to 5 mm depth (often 7 Gy x 3). Because of the inverse square law, the dose to the non-prescription point will vary as a function of cylin...
What is the appropriate treatment approach for a primary squamous cell carcinoma of the trachea?
Treating tracheal malignancies is obviously challenging. I typically determine treatment based on the location of the primary. Upper tracheal (above the sternal notch) I treat more like a HN cancer while below that I treat more like a lung cancer. Upper tracheal cancer are more difficult to resect d...
Do you hold nivolumab and ipilimumab when giving palliative radiation to abdominal targets?
This is similar to the question of whether you should hold bevacizumab for palliative radiation. You cannot really change the biologic effects of these agents immediately by holding them. The toxicity has been repeatedly shown to be minimal in trials where radiation has been included with concurrent...
What's your approach to adjuvant therapy for neuroendocrine (small cell) cancer of the parotid gland?
While it is rarely possible for a primary NE cancer to arise in the parotid, the vast majority of these are actually Merkel cell carcinomas (MCC) secondary to a skin primary in the draining zone of the parotid (or pre auricular nodes) in the face/scalp. Even if a primary were to be never detected, w...