Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you always obtain PSMA PET as initial staging for high risk and very high risk localized prostate cancer patients?
I do obtain a PSMA PET/CT or PET/MRI in all patients with high risk localized prostate cancer. However, when this is not available due to insurance coverage issues or lack of access to PSMA PET, it is still acceptable to stage with bone scan and CT or MRI. I prefer PSMA PET because it has better per...
When would you consider adjuvant radiation therapy for tenosynovial giant cell tumors of the extremity?
Yes, if it was recurrent or subtotally resected.
When treating with electrons, what is your approach to skin collimation to reduce penumbra next to structures such as the eye?
Skin surface shielding/collimation can be accomplished by a few methods. One is to create an impression of the patient and then conform thin sheets of lead/high density shielding material to this shape with an appropriate aperture for the target. This is time-consuming but preferable for small targe...
What is your approach to rectal cancer staging in patients who cannot undergo an MRI?
Endoscopic ultrasound of the rectum in addition to CT scans with contrast, if any doubt, will do a PET/CT scan.
Are there single fraction regimens for postoperative treatment for keloids?
10 Gy in a single fraction Ragoowansi et al., PMID 12711944
Is prior TURP a contraindication to SpaceOAR placement?
It's worth a try. Most of the time, I haven't had an issue. Occasionally, a TURP or other procedure can lead to more fibrosis in the rectoprostatic space that can make it hard to hydrodissect. But typically, it is not an issue.
How do you manage postoperative head and neck cancer patients who have difficulty completing simulation due to copious secretions?
In addition to elevating the head/shoulders as much as technically feasible, if there aren't contraindications, I've used a scopolamine patch applied two days before the sim with variable success.
In the Nebraska/Mayo transplant protocol for perihilar cholangiocarcinoma, do you ever offer prophylactic biliary drainage/stenting to prevent obstruction post-chemoradiation?
We use an ERCP-placed nasobiliary approach to biliary brachytherapy as part of our pre-transplant CRT regimen for patients with peri-hilar cholangiocarcinoma (Murad et al., PMID 22504095). Our technique is described by Deufel et al., PMID 29776892. Patients with baseline tumor and/or comorbid diseas...
How would you treat an elderly patient (ECOG 0-1) with locally advanced rectal cancer and synchronous Merkel cell cancer of the extremity requiring adjuvant RT?
Interesting - the flurry of activity came several months after I treated the patient. The patient was not going to get further surgery for either. I choose to treat with definitive CRT (Xeloda) to 54 Gy w VMAT. I treated the Merkel Cell with 30/10 at the same time, presuming the patient would have a...
Do you change your monitoring strategy for a high risk prostate cancer after XRT if the initial PSAs have never been very high?
In general, a patient whose volume of cancer is out of proportion to their PSA makes me nervous. So, I'm much more worried about the patient with a PSA of 5 and multiple cores positive for high volumes of Grade Group 4-5 cancer than I am about the patient with a PSA of 5 and a single positive core s...