Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you fractionate prostate cancer where there was rectal wall infiltration by hydrogel after healing?
For superficial infiltration, I do not change approach. For deeper infiltration with delamination of muscle layers, especially muscularis propia, I typically switch to moderate hypofractionation (60Gy/20 regimen) and treat whole spacer gel area as part of rectum OAR. We have done this systematically...
What dose do you use for T2 anal squamous cell carcinomas measuring greater than 3cm?
These dose questions are very difficult to answer. 50.4Gy and 54Gy are both acceptable answers to this question. Most academic centers use their own data to justify the doses that they use. To give you an example, when I started my career at MD Anderson in the 3-D era, every patient got 55Gy. When w...
How would you manage a medically inoperable patient with an invasive squamous cell carcinoma of the oropharynx and extensive adjacent leukoplakia harboring pathologically-proven in situ disease?
Definitive chemo RT using hyperfractionation or SIB with weekly cisplatin. I would treat the CIS and reduce off of it at 64 Gy.
What is the appropriate time interval to assess treatment response in primary vaginal SCC?
I would favor biopsy before any intervention. If positive, would need surgical salvage (similar principle as cervical cancer).Beaty et al., PMID 34455989 This review gives some biological differences between cervical and other HPV-associated malignancies.
How would you approach a patient with stage I gastric MALT who achieved a complete response to chemoimmunotherapy after only 2 cycles?
Although MALT lymphoma generally responds well to chemo immunotherapy, long-term cure is seldom achieved. For early-stage gastric MALT not suitable for antibiotics or failing to respond to same, radiotherapy alone is the treatment of choice, dose 24 to 30 Gray. I would not alter the radiotherapy pla...
Are there any situations where you would consider neoadjuvant chemoradiation as opposed to chemoimmunotherapy for patients with resectable NSCLC prior to surgical resection?
For most of the last 2 decades, there has been a raging debate about the best perioperative approach for the management of patients with high-risk resectable NSCLC, such as patients for example, with preop documented nodal disease. Clinical studies have not been able to settle the key questions whet...
What are various positioning and treatment techniques you use to help reduce bowel dose?
Prone position IMRT/VMAT I tend to use both concurrently for rectal/anal/some gyn. There is a "myth" that prone position is difficult to reproduce. Studies do not show this, or if there is an effect, it can be mitigated by image guidance. Here is another study showing this.
What criteria does your institution use to indicate patient is ready for PEG tube removal?
The short answer is we typically advise patients that if they can maintain an oral diet (using the tube for flushes only) for 2 weeks and demonstrate no weight loss they are typically ready for tube removal. Our patients though are followed through the course of their treatment by a dietician, and t...
How would you manage a symptomatic marginal zone lymphoma of the base of tongue causing globus sensation also incidentally found to have squamous cell carcinoma in situ?
I would not irradiate a Stage 0 oropharyngeal cancer, much less irradiate the necks electively. But this is not just a CIS (TisN0M0 of the base of tongue) case; this is a very interesting/rare case presentation of what strikes me as a kind of Waldeyer's ring "MALToma" of the lingual tonsils. MALToma...
How do you approach hippocampal sparing RT in the setting of peri-hippocampal metastases?
Not unless there is a reason to do so.