Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage HPV positive squamous cell carcinoma in situ of the oropharynx?
transoral surgery
In what situations do you recommend preoperative chemoradiation for gastric cancer?
I very rarely use preoperative radiation therapy in true gastric cancer. The data on RT in gastric cancer is mostly postoperative RT. In the past I have used RT for the rare distal lesion that was not resectable without a Whipple to try to convert the tumor to resectable. Even in that situation, I w...
Is there any mature data about cognitive outcomes in 12 Gy vs 18 Gy in the setting of prophylactic cranial irradiation for ALL in children?
There is some data on AML showing some differences between 12 vs. 18 Gy, yet still quite a low incidence.https://www.ncbi.nlm.nih.gov/pubmed/214804694/134 (3%) of patients treated with 12 Gy versus 8/108 (7%) of patients treated with 18 Gy demonstrated behavioral disorders and cognitive impairment. ...
Would you recommend a cycle of chemotherapy prior to concurrent chemoradiation for a Stage III NSCLC patient who needs to start treatment sooner than allowed by the IMRT planning process?
For a patient who has symptomatic airway disease requiring urgent intervention, they should be stabilized with airway stenting and high-dose steroids to allow time to generate a good IMRT plan. Induction chemotherapy has no guarantee of improving symptoms and has been shown in the CALGB study (Vokes...
How do you approach SRS reirradiation for brain metastases overlapping previous sites of SRS?
This situation has several variants. First of all its incidence should be about 5% in most SRS cases. Second all retreatment decisions should be made following co-registration of current images with treatment images. Easy to be tricked based on scan angle. Variant 1: Response followed by recurrence ...
How does pelvic radiation impact a patient with a known iIliac aneurysm?
I have done few patients and have not changed management or RT dose based on aneurysm. I do tell patients we don’t know the long term effect but have not seen any early complications.
When would you recommend hyperbaric oxygen treatments for skin ulceration/non-healing wounds in a radiated field?
I agree with @Dr. First Last' answer. Careful planning and attempts to avoid non-healing wounds is important, but this can happen. Conservative management should be used before hyperbaric O2 except for severe toxicities such as radiation optic neuropathy where all reasonable measures should be consi...
How do you counsel a patient with breast cancer and a rad50 mutation when deciding between lumpectomy and radiation vs mastectomy?
There are currently no data suggesting that a heterozygous RAD50 mutation is associated with increased clinical risk of radiation toxicity and I would not alter treatment options based on this information. While it is a DNA repair molecule, this does not de facto indicate a risk for radiotherapy. BR...
Would you recommend APBI in a suitable candidate if they have pre-existing breast implants?
I have not done it but there is good data of using interstitial brachy for APBI in these patients from Dr Kuske. I have used SAVI and there are reports of using SAVI device as they can be used for small cavity which most of these patients have. I can cover the prescription isodose line up to the cap...
How do you talk to patients about clinical trials?
I try to incorporate the clinical trial idea into the standard of care recommendation/discussion at the time of initial treatment decision making. After making a standard of care rx recommendation, I tell patients that my recommendation is based upon this treatment being the winner of a prior trial ...