Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your approach to adjuvant vaginal cuff radiation in patients with prior definitive pelvic radiation therapy?
I do take the previous dose into account. Sometimes use a multichannel cylinder and try to control the rectum and bladder dose. Also, prescribe lower end of acceptable dose schedule like 6 Gy x 5 to surface or 4 Gy x 6 to surface.
In a patient with rectal adenocarcinoma and involved gluteal lymph nodes, what would your elective lymph node volume include?
I think the most important issue to address in this case, is how disease accessed the subgluteal space. I had a case like this in a patient with a very deeply invasive disease. During chemoRT, the patient required a diverting ileostomy after they developed a recto-cutaneous fistula due to rapid tumo...
How would you sequence treatment of a synchronous IC1 high-grade serous ovarian cancer and cT3N1 rectal cancer?
Do you dose escalate a patient with high risk prostate cancer who refuses ADT due to potential side effects?
I would treat the elective pelvis to around 50 Gy with a simultaneous boost to the LN to as high as tolerable based on proximity to the bowel. The prostate should be taken to normal dose-escalated levels depending on your fractionation, and you can add a microboost to a DIL. I generally do not add a...
Is polymyalgia rheumatica associated with increased toxicity for lung SBRT?
No data here that I can speak to. Lung involvement is exceedingly rare in PMR and generally, I wouldn’t consider this a disease associated with increased risk of inflammatory response within the lung parenchyma. There are some reports of associated GCA, BOOP, and other interstitial lung findings in ...
What is your approach for treating oligometastatic head and neck cancer to an adjacent nodal site (ie. axilla, mediastinum etc.) with radiation therapy?
If limited chemo RT with curative intent.
Would you hesitate to give breast radiation to a patient with prior near-fatal Stevens Johnson medication reaction?
Although this is an extremely rare occurrence when looking at the literature on this subject, limited to case reports/series, I think that I would hesitate to give breast RT in this case. This is based on the fact that in this case, it is DCIS that is being treated, and despite the DCIS being recurr...
Is there a time interval after which you would not offer adjuvant radiotherapy for a malignant, grade 3 meningioma?
Adjuvant radiation for grade 3 meningioma is based on prior observational studies that generally reflect recurrence rates approaching 90% for grade III disease, and the insufficiency of salvage treatment approaches.Given the small numbers of grade 3 tumors, and the heavy bias towards upfront postop ...
When, if at all, do you use nasolacrimal duct stents to prevent stenosis/obstruction when treating skin, sinonasal, or other mid-facial H&N cancers with radiation therapy?
I don’t because when the stent is removed, the duct stenoses.
In a patient with history of successfully treated locally advanced H&N cancer, how do you discern between a metachronous second primary locally advanced lung SCC vs. metastatic head and neck SCC?
Solitary, particularly long interval, N0-N1, treat like lung primary. Multiple lesions, short interval, advanced neck disease, likely metastases.