Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How long after pancreatic SBRT do you wait to re-image?
Standard imaging interval after preoperative long course radiation has been 5 weeks, by that analogy after a 1 week course of radiation it should be longer but it's an arbitrary decision. The only thing I would avoid is operating in less than 5 weeks because the acute reactions need to resolve. In t...
What rate of second malignancies do you quote for patients receiving radiosurgery for benign CNS tumors?
<1% at 10 years based on following Lancet Oncology paper: https://www.ncbi.nlm.nih.gov/pubmed/30473468
Would you consider PMRT in a patient with N0(i+) luminal A disease?
ITC upfront at this point would not sway decision for PMRT unless it is ITC after neoadjuvant systemic therapy
What dose-fractionation would you utilize to treat a multiply recurrent high-grade urothelial carcinoma of the bladder in a patient who is not a surgical nor chemotherapy candidate?
55 Gy in 20 fractions over a 4-week period like MRC
What is your preferred approach for stage III NSCLC with single station N2 disease amenable to lobectomy?
The question of how to handle operable IIIA patients with limited N2 disease has always been controversial, and the new PACIFIC data just makes it more complicated.At some level, it becomes a duel of unplanned subset analysis and a bit of apples to oranges, which is always to be taken with a grain o...
Do you routinely treat the anterior oblique breast suprclav field with 6MV photons or do you use a higher dose, such as 10+ MV?
In the era of 3D planning to cover axilla and s/c area in breast cancer use of high or mixed energy to cover nodes is very common as they are deeper than what can be covered with 6MV without exceeding hot spots size and volume
What anesthetic spray do you use (if any) for numbing the nasal passages when performing nasolaryngoscopy?
I prefer a combination of an anesthetic mixed with a vasoconstrictor. For the anesthetic component, lidocaine with a potency of 2% or higher will suffice. Phenylephrine or oxymetazoline are the typically available drugs for opening the nasal passages. These can be compounded in a solution by the pha...
How do you manage metal dental fillings/prosthetics and hot spot concerns for head/neck radiation?
We use a devise we call "teeth guard", made of polyvinyl siloxane putty described in an article by Ben David M et al. It has a thickness of about 5 mm, which is the typical range of the secondary electrons scattered off metal in the teeth, to reduce hot spots in the gums and tongue. The device and i...
Do you perform a bone health assessment in men who will be receiving short term androgen deprivation for localized prostate cancer?
I do not order bone densitometry on patients I am treating with short term (<= 6 months) of AD, unless they have a risk factor like long-term glucocorticoid use or prior fracture. For patients I am treating with long term >=18 months I perform a baseline bone densitometry. If that is normal-mild ost...
Is there a role for treating actinic keratosis with superficial radiation therapy to widespread areas on scalp?
No.