Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage dyschezia and tenesmus following TNT with short course RT?
Specifically for the management of moderate to severe tenesmus and pelvic pain/cramping, I’ve found that combinations of steroids, bentyl, and gabapentin are very effective. Another consideration, if sequencing short course RT prior to chemotherapy, is to delay chemotherapy for 2-4 weeks after short...
In a patient with both Stage III NSCLC and another concurrent high risk malignancy, how do you sequence consolidation durvalumab with local therapy for the concurrent cancer?
I pretty frequently see either 1) concurrent LA-HNSCC and stage III lung, or 2) concurrent stage III and stage I NSCLCs. I wouldn't pause or delay the durva in either scenario. Quite a bit of literature now supporting the safety of concurrent RT (even high dose per fraction/SBRT) and immune checkpoi...
What skin care regimen do you prefer during radiation for patients with inflammatory breast cancer?
The treatment of acute skin reactions is historically a morass, with most centers and physicians (including ourselves) doing different things based on limited evidence and lots of hoary mythology. The myth that most bothers me is patients being told not to use moisturizers before treatment. A phanto...
In your experience, is a bra worn during radiation treatment for large-breasted patients ever beneficial?
I have used styrofoam wedges in the infra-mammary fold to reduce the effect of skin folds. I would suggest placing these wedges in a fixed position with markings to help reproduce the position.It's also important to realize that in order to reduce the risk of treatment-related morbidity, one can als...
What is palliative RT technique would you use to treat a secondary lymphoma of the scrotum without skin involvement?
Technique depends on the dose being given and how the toxicities of that dose may affect the patient. If this is a low-grade lymphoma receiving 2 Gy x 2 or 2 Gy x 12-15 then I don't think the toxicity with a well planned 3D (with FiF as necessary to minimize heterogeneity) is likely to cause too man...
Would you ever initiate steroids during conventional lung radiotherapy in a patient who develops dry cough during treatment?
I have not yet done so, though I would never say never (perhaps worth considering if cough is very severe, if V20 or MLD is very high, and if one can see significant inflammatory changes on CBCT). Instead, I tend to treat the cough with typical supportive medications.
What is your PSA threshold for obtaining PSMA PET for biochemical failure after RP?
I typically order a PSMA PET after ~0.20. Sometimes lower if there are multiple aggressive features or poor prognostic factors (i.e. SVI with no lymph node dissection and persistently positive PSA of 0.15 after RP). This approach seems to be a reasonable threshold to me based on two considerations: ...
Do you recommend ADT for a high risk prostate cancer patient who had SBRT?
SBRT doesn’t mitigate benefit of ADT and the type and duration have to be the same as with EBRT or EBRT plus brachytherapy.
Is ultra-hypofractionation to the whole breast an appropriate adjuvant radiation treatment for Paget's localized to the nipple, status post central lumpectomy?
I would use the same principle as we use for non Paget's DCIS or IDC for use of ultra hypofractionation.
To obtain insurance approval for DIBH when treating left breast cancers, are there particular dose constraints to sites that you employ?
I am surprised insurance companies are still restricting the use of DIBH for left side breast cancer and need some metrics to support it. Mean dose to heart is low with DIBH as it helps to restrict scatter and transmission from conformal heart block and knowing each Gy to the heart matters, DIBH is ...