Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the earliest you would start postmastectomy radiation after adjuvant chemotherapy for a patient with breast cancer?
Depends on the chemo regimen. If on 3/4 weekly chemo then wait for 3-4 weeks before starting RT but if on weekly chemo (taxol), then have done sooner also.
Would you offer nodal RT for pT2N0 triple negative breast cancer s/p BCS?
I agree with above and generally haven't routinely offered RNI for such patients. However, I consider making an exception in the setting of a tumor with multiple risk factors, such as medial location, young age, large T2, poor response to neo-adjuvant chemotherapy (so cT2N0, ypT2N0) with LVI, etc.
What region would you treat in a patient with high grade leiomyosarcoma localized to the spermatic cord with close margins (<1mm) s/p inguinal orchiectomy?
I would refer you to the excellent answers on this topic from a previous query on theMednet: https://www.themednet.org/question/5712 I see in your case there was a close margin - I would add that it's important to know if the margin was close at the longitudinal aspect of the resection along the spe...
How would you deliver salvage prostate bed radiation in a patient with a neobladder?
In a situation like this, I think the risks of an adverse event are higher and the chance of cure lower than the average patient. Thus, the anticipated behavior of the cancer will play a strong role in the decision about whether to treat or not. Factors like the Gleason score, risk factors for a rec...
Would you start any treatment for radiation pneumonitis if there is a large area of consolidation in the irradiated lung field but the patient is asymptomatic?
If the timeline matches then for radio graphic only pneumonitis, I would favor observation with a repeat scan in a few months.
Is there a role for nintedanib in the management of patients with radiation-induced pulmonary fibrosis?
There is no phase III evidence I am aware of on the benefits of nintedanib in the prevention of radiation-induced pulmonary fibrosis so it is not a drug I use. There are a few case reports and some pre-clinical studies suggesting an effect. There is a small (34 patients) randomized phase II study th...
How do you account for treatment breaks longer than one week for patients with anal cancer receiving definitive chemoradiation?
I don’t think there is a “one size fits all” approach to this scenario and in general, practice is not supported by high level evidence. We do have a wealth of data to suggest that prolongation of the overall treatment time for squamous cell carcinoma (head/neck, uterine cervix, anal canal, etc) is ...
What personnel does your department require to safely deliver vaginal cylinder brachytherapy, other than treating radiation oncologist and physicist?
We have dedicated nursing staff and specialized brachytherapy radiation therapists who are all integral for all of our procedures, including vaginal cylinder brachytherapy.
Would you advocate for sphincter preserving chemoradiation therapy for a patient with a diagnosis of anal canal carcinoma who has previously been treated with pelvic radiation such as EBRT or brachytherapy?
The dose of the prior radiation is very important. If the sum is greater than 100Gy, there will be a risk of urinary or rectovaginal fistula formation. If the prior radiation was only adjuvant and there is a window of opportunity for definitive treatment. The acute reactions are no worse because the...
What dose and fractionation do you use for palliative radiotherapy of GI carcinoid tumor metastatic to spine/bone?
With all metastatic neuroendocrine tumors, given the generally good life expectancy (as compared to more common metastatic GI carcinoma), all therapy must be aligned to provide maximal local control and minimize side effects or other potential therapeutic options. While historically felt to be radia...