Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer definitive radiation for a T1N0 glottic larynx SCC in a patient with a history of RAI treatment?
Absolutely
Is it safe to deliver palliative radiation to the spine with a spinal stimulator device in place?
There are 3 components in a spinal cord stimulator, the electrodes that are implanted in the epidural space, the implantable pulse generator, and the wiring connecting the two former components. The implantable pulse generator is similar to a cardiac pacemaker and it is the most important component ...
What isotope and dose do you prefer for prostate brachytherapy monotherapy?
Superior dosimetry - palladium 103 Faster half-life decay Lower risk to the patient's family and medical personnel Less of an issue with subsequent urologic procedures such as TURP
What dose-fractionation would you use for cutaneous head and neck squamous cell carcinoma status post resection and skin grafting?
I use the same fractionation schedule that I would use otherwise. Split thickness grafts tolerate radiation poorly, particularly on the scalp. Free flaps are preferred. 60 Gy/30 Fx for negative margins, 66/33 for positive margins, and 70/35 for gross disease.
Would you consider radiation omission in an elderly patient with a 2 mm focus of invasive ductal carcinoma in a background of high-grade DCIS?
I think there is a role in shared decision-making here. Based on the data we have, there is no survival difference with the addition of RT in this situation. Radiation will improve local control. When it was a choice of 5 weeks for that benefit, many chose to omit. With 5 fx, it's a different discus...
Do you contour and constrain the sublingual glands?
Agree with Dr. @Dr. First Last. I would like to comment that while level I is a target in OC cancer, the submandibular gland is not. Embryonically, the parotid glands develop before the lymphatic system does, such that lymph vessels enter it. In contrast, the SMGs develop after the lymphatic system ...
Do you hold mTOR inhibitors during radiation?
MTOR inhibitors may be radiosensitizers but in limited times, I have not held this drug for palliative RT.
Is a FAST regimen reasonable for re-treating a patient with PBI after prior whole breast radiation ten years ago?
May be reasonable but for now, we prefer 40 in 15 PBI using VMAT or multibeam IMRT.
How would the development of pneumonitis from pembrolizumab after treatment as per Keynote 522 alter your PMRT recommendations?
If recovered completely, I would proceed with PMRT.
Do you always obtain PSMA PET as initial staging for high risk and very high risk localized prostate cancer patients?
I do obtain a PSMA PET/CT or PET/MRI in all patients with high risk localized prostate cancer. However, when this is not available due to insurance coverage issues or lack of access to PSMA PET, it is still acceptable to stage with bone scan and CT or MRI. I prefer PSMA PET because it has better per...