Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there harm in doing a radiation oncology fellowship?
Short answer: yes. Detailed explanation below. Your excellent question brings up the fact that there are currently more and more non ACGME accredited fellowships emerging (More than 20 the last time I checked!!! Some programs even have multiple fellowships, and there is even a 2 year fellowship whic...
When pre-operatively treating high grade soft-tissue sarcomas involving the chest, abdomen, or pelvis what margins do you use for CTV and PTV?
Hi, there are some recently published consensus guidelines for pre-operative radiotherapy for retroperitoneal sarcomas. These in general recommend a 1.5-2 cm CTV margin if an 4D imaging and an ITV is used, with larger sup-inf margins (up to 2.5 cm in the upper abdomen) if 4D is not used to delineate...
Would you offer radiation therapy to a patient with sigmoid colon cancer that is medically inoperable?
Interesting question. First off, sigmoid cancers are treated as a 'typical' colon cancer; therefore, radiotherapy has a very limited role outside of loco-regional palliation efforts, perhaps. Second, though the patient is medically inoperable, is the cancer actually in the sigmoid colon, and is it r...
What is the case for or against using protons for lung SBRT?
Proton therapy is a tool in the radiation toolbox to use when needing to take advantage of avoiding normal tissue. For the vast majority of cases, proton therapy is not needed for lung SBRT and of course, there are concerns about motion, low density targets, under coverage, and beam overshoot. But.....
How do you manage in-field perineural recurrences in the skull base?
If it is low volume recurrence, I favor a stereotactic radiotherapy approach over 1-5 fractions.
Do you routinely offer consolidation RT to sites of previous bulky disease in stage III and IV Hodgkin's lymphoma who have a complete metabolic response on restaging PET/CT following 6 cycles of ABVD?
Update - 1/5/24Three important studies have been published in the last few years which shed light on the role of RT in advanced HL in the setting of a negative interim (and post-chemotherapy) PET-CT.The RATHL trial included 1,119 patients with IIB-IV (or IIA with either bulky disease or at least 3 s...
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
Anorexia/cachexia is often distressing to patients and families and it is this distress that is the target of many of the interventions for this syndrome as there are, in general, no effective therapies. Patients and families are routinely battling over the lack of eating as this causes further disc...
Would you recommend SBRT in the adjuvant settings for a solitary metastasis focus in the abdominal wall resected to R1 in a young and healthy patient with clear cell ovarian cancer?
If it is truly an R1 resection, I would observe and follow with close imaging.If she recurs, I would recommend a discussion for systemic therapy. If she has persistent disease that is amendable to SBRT, it is reasonable to treat. SBRT can prolong a chemotherapy holiday and dosing in the pelvis is us...
What treatment volume and dose would you recommend for locally advanced NSCLC with CR after induction chemotherapy?
Interesting question. I haven't yet been in this situation but for me, it would depend on which had a CR, the primary and/or nodes. If the primary has had a complete radiographic response and there is no target, then I personally would not try to target the area where it was as I personally don't li...
How do you manage acute keratoconjunctivitis following total skin electron therapy (TSET)?
Institutions approach total skin electron beam therapy (TSEBT) somewhat differently. I generally try to utilize external eye shields as much as possible. If a patient doesn't have active disease involving the eyelids or peri-orbital skin, this obviates the need for internal eye shields which reduces...