Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage radiation cystitis in a vulvar cancer patient still receiving EBRT with known history of cystocele and who is otherwise hemodynamically stable?
For me, this is a very confusing question. First, I am not sure what is meant by "radiation cystitis." The question seems to imply that the patient is having hematuria as a component of the radiation cystitis diagnosis. In my long career, I have never seen a patient have noticeable hematuria during ...
In patients with perianal squamous cell carcinoma extending to the vulva, would you cover the entire vulva or would generous margins on the gross disease suffice?
I would generally favor treating with generous margins as opposed to intentionally covering the entire vulva. However, for patients who have a prior history of vulvar lichen sclerosis or vulvar intraepithelial neoplasia where the risk of developing vulvar cancer is higher, I would consider covering ...
For path CR after neoadjuvant chemotherapy in breast cancer with sentinel node (2-3 nodes) negative but >4 nodes positive on initial PET, do you boost the nodes not assessed by sentinel node?
I have boosted the epicenter of these undissected nodes if can identify on CT sim for planning. For CR or pCR in other nodes usually use 56 to 60 Gy and if non pCR or nodes are still enlarged (like IM or s\c) to 60 to 66 Gy.
Do you have experience using photobiomodulation (Low Level Laser Therapy) to prevent and/or treat patients with oral mucositis or other side effects from chemo and radiation?
Taylor et al., PMID 36474663 Is anyone using this routinely as per the cited article?
In a patient with very high risk prostate cancer opting for prostatectomy, when, if ever, do you recommend neoadjuvant ADT?
I generally do not offer ADT with or without a potent ARSI prior to RP even in high risk disease. While small single arm studies have shown that a few such men can achieve a pathologic CR and that path CR/MRD is associated with better outcomes after RP, for most patients, this approach has no clear ...
How do you approach Spine SBRT to 2 separate noncontiguous vertebral bodies ?
I would feel comfortable treating concurrently. But, sequentially is fine, too. The vertebral SBRT RCT allowed for 3 consecutive to be treated, so if non-contiguous, would use the same planning criteria.
Do you continue to obtain dedicated imaging of the spine after palliative radiation for epidural disease or cord compression?
If palliative, I do not routinely get imaging after treatment. The best way to know if it has worked is if the symptoms stabilize or resolve. Imaging is reserved for when a patient has worsening or return of symptoms. If oligometastatic and treating to higher dose/ablating, would consider imaging af...
Would you alter radiation recommendations for a patient with locally advanced rectal cancer and a history of abdominopelvic lymphoma radiation 40 years ago?
In the case of more recent RT, I would get the records in order to inform treatment recommendations. However, records are typically impossible to get in this situation. We have several options here. The first is the avoidance of radiation, as was recently reported in the PROSPECT study. (Schrag et a...
Would you offer post-operative radiation for a T2N0 rectal cancer with less than 12 lymph nodes found in the specimen after LAR?
I would like to know further details of the pathology before making a recommendation regarding post-op RT: location of the tumor - low vs mid vs high rectum, resection margin status, LVSI, EMVI. All these factors can help make a predictive assessment regarding the risk of local recurrence. For mid-...
What definitive dose would you use to treat a recurrent basal cell carcinoma in the oral cavity?
I don’t recall seeing a BCC in the oral cavity. Lips? 66-70 Gy at 2 Gy per fraction.