Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider treating the regional nodes in addition to the breast in a patient with skin involvement (pT4b) after a lumpectomy with negative margins/nodes who refuses chemotherapy?
I can't say that this is a commonly encountered scenario. It's tough to imagine the T4 patients that's a good upfront BCT candidate. In my opinion, it is very reasonable to consider RNI in a high risk node negative patient. High risk N0 patients were included in MA.20 and EORTC 22922 and derived sim...
Would you recommend PMRT in a patient with a microinvasive component but a large DCIS component who had a mastectomy with negative margins?
Patients with DCIS treated with mastectomy and negative margins wouldn't get PMRT, so this patient wouldn't either. Essentially, they have an extensive intraductal component, and EIC with negative margins is not a risk for recurrence, thus PMRT would not be warranted.
For patients you treat with LDR prostate brachytherapy, how do you sequence treatment with external beam radiation therapy?
We use EBRT followed by LDR brachytherapy in 3-4 weeks time
What interventions besides lubricants do you advise to improve sexual satisfaction for patients s/p ChemoXRT for cervical cancer?
Advise a multimodal approach Additional strategies: 1) Vaginal dilator therapy. Additional visits outside of follow-ups may improve adherence 2) Vaginal moisturizers - Replens, Vitamin E oil, etc. This is outside of water-based lubricants during sexual activity 3) Topical estrogens (many of these pa...
How to you account for motion when contouring head and neck primaries in more mobile areas such as base of tongue and larynx?
We instruct our patients not to swallow during the CT simulation. We do not account for organ motion when contouring. The duration of intrafraction swallowing during the entire course of conventional RT has been reported to be small, at 0.43% of the total irradiation time (1). van Asselen B, Raaijma...
Would you recommend pre operative (chemo)radiotherapy for a patient with a T3 N0 low rectal cancer in a patient with active Crohn's disease?
Personally, I would not recommend neoadjuvant radiation therapy. Assuming the patient is a candidate for FOLFOX chemotherapy if appropriate after surgery and pathological staging, the benefit of radiation is probably a single digit decrease in local failure. Pelvic recurrences are terrible, and that...
Is postoperative radiotherapy indicated for a 5 cm grade 2 synovial sarcoma of the knee joint?
Our approach is to treat with adjuvant radiation for any grade 2 or 3 sarcoma; thus even in this case, I would recommend treatment.I would consider smaller margins per the VORTEX trial (abstract https://www.redjournal.org/article/S0360-3016(16)30347-9/abstract ) and if wide margins would treat to 60...
Are there any contraindications to or concerns with radiating a rectal cancer patient receiving bevacizumab?
Bevacizumab has a modest radiosensitizing effect and the combination has tried to improve response rates in rectal cancers. At radiation doses normally used to treat rectal cancers, the combination does not significantly increase toxicities and hence considered safe to use. However, radiation is oft...
Is it safe to offer head and neck radiotherapy to a patient with a diagnosis of porphyria such as erythropoietic protoporphyria or porphyria cutanea tarda?
Gunn et al., PMID 19536857.
What considerations do you take when performing functional SRS for tremor?
Performing functional SRS for tremor is a complex treatment that is ideally performed in a multi-disciplinary setting in collaboration with a functional neurosurgeon and movement disorder neurology team. That being said, it is a very rewarding treatment as it can provide incredible QOL improvement f...