Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend radiation therapy for a pathologic vertebral compression fracture already treated with kyphoplasty and RFA (OsteoCool)?
Assuming there is active disease in the vertebral body in question, I would recommend radiation therapy. An abstract was presented at the last ASTRO describing a retrospective small series from Roswell Park (Prezzano et al) suggesting that the combination of RFA and RT was beneficial for spine metas...
What duration of ADT + abiraterone do you recommend prior to initiation of HDR brachytherapy followed by EBRT for very high risk localized cT3bN0 prostate cancer?
This is a short answer (for me) given the lack of data to support brachy boost in T3b disease in a randomized trial.The only randomized multicenter trial comparing dose-escalated EBRT to brachy boost is ASCENDE-RT. They specifically excluded T3b patients (see supplementary content for all exclusion ...
How do you plan prostate radiation in a patient with a sacral nerve stimulator?
I have treated a few patients with pelvic nodal RT with sacral nerve stimulator and just asked it to be switched off during CT sim and daily RT.
How do you approach adjuvant radiation for perihilar cholangiocarinoma?
There should certainly be multi-disciplinary discussion, as while RT can augment locoregional control in the adjuvant setting and should strongly be considered, there is a paucity of high-level data. SWOG 0809 was the first prospective study (single-arm phase 2) of adjuvant therapy in stage pT2-4 or...
How do you contour a resected brain metastases for fractionated partial brain radiation?
When treating a resection cavity in the brain after surgical excision of the tumor, I contour the resection cavity on a Gd-contrast enhanced volumetric MRI. For most large metastases, an average cavity volume reduction of 15% to 43% has been reported in several published studies within 3-4 weeks aft...
How do you manage patients with dementia who require but cannot tolerate an aquaplast mask for radiation therapy?
Tape
What is the best way to manage severe claustrophobia and anxiety for Thermoplastic masks?
I’ve found that P.O. uptake of benzodiazepines is notoriously unreliable, and often the severity of patients’ anxiety isn’t apparent until after the process has begun. Because of this, I stock IM hydroxyzine (a.k.a. Atarax or Vistaril), which is a great non-narcotic old-school anxiolytic with a reli...
If treating a patient with prior breast augmentation with whole breast radiation, would you alter your field setup?
With prior breast augmentation, I think you have a few options. Whole breast irradiation with tangents - I typically cover the entire chest wall and don't move the field edge forward. With respiratory motion (unless using DIBH or other respiratory techniques), I do worry about missing areas at risk...
For postmastectomy patients who have >2 sentinel nodes involved, would you recommend a completion axillary dissection or proceed with PMRT?
This is a question that is still debated. I am comfortable extrapolating AMAROS/Z011 to mastectomy patients despite the limited number of patients undergoing mastectomy in AMAROS.In patients with 2-3 SLN involved (that were cN0), I would be ok with PMRT and omitting ALND as long as no ECE. If > 3 LN...
How would you simulate and ensure set-up reproducibility for a patient with head and neck cancer and severe claustrophobia and unable to tolerate a thermoplastic mask?
Options: Make a mask and cut out the face area, keep the chin and forehead. Use cushion tape at the edge to make it more comfortable. Use surface imaging device (Identify, VisionRT, C-rad) with good custom vaclok of the head and neck area. Use of anti-anxiety meds and music therapy (patient's own m...