Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach treatment for high-risk prostate cancer in patients who need clearance for organ transplant listing?
Our initial approach for these patients is to engage their transplant physician to understand the barrier for organ transplant listing. For some patients, the presence of a detectable PSA is the rate limiting factor, while for others having untreated disease is the main issue. The difference between...
How do you approach radiation treatment planning for prostate cancer in a patient with microscopic colitis?
It's been my observation that most radiation oncologists have a visceral reaction whenever thinking about prescribing ionizing radiotherapy to patients with any type of inflammatory bowel disease. As such, the idea of a prostatectomy in this situation typically emerges as the preferred option, with ...
How do you balance aspiration risks with encouraging PO intake for HN cancer patients during and after chemoradiation?
The main challenge is to identify the patients who are most prone to aspirate during and after Tx. Chemo-RT-related aspiration is frequently “silent”: the patient does not recognize he/she aspirates, and neither does the observer. The risk of aspiration is assessed by modified barium swallow perform...
Would you recommend hypofractionation in breast cancer patients who had partial mastectomy with significant oncoplasty?
In the absence of robust data suggesting that use of oncoplasty should alter whole breast radiotherapy recommendations, hypofractionation is our preferred approach following partial mastectomy with oncoplasty in patients without indications for regional nodal irradiation. According to 10-year follow...
In a patient with prostate cancer who developed prostatits after placement of fiducials, how long does one wait before initiating radiation treatments?
Prostatitis can be difficulty to clear, especially with the introduction of a foreign body into the infected organ (i.e., the fiducials). Also, the symptoms resulting from irradiating the prostate can mimic those of prostatitis, so I want to be as certain as possible that the infection has cleared b...
What is the rate of a cardiac events that you quote to a patient with preexisting heart disease going on trastuzumab for metastatic Her2+ breast cancer?
I tell patients that it depends on their baseline risk factors and that some have reported rates as high as 25-28%. I discuss that if they have had prior anthracycline therapy, borderline baseline LVEF (50-54%), age > 65, and other cardiac risk factors like hypertension, that they could fall into th...
How do you manage T1-2 SCC of the lip postoperatively?
In my practice, the decision to re-resect vs RT in patients with close margins or high grade dysplasia depends on the ability to identify and reliably resect close or dysplastic margins without risk of oral incompetence.
Given the biochemical failure definition of PSA nadir+2 ng/mL, how do you approach a PSA bounce of magnitude 2 ng/mL or higher?
If a PSA bounces >2 points then PSA decreases subsequently without any treatment, I do *not* consider these patients to have failed. This does occur in the clinic occasionally. Thankfully, when patients have rising PSAs after RT, there usually is not an urgency to start salvage treatment. When a pat...
How do you manage urgency and frequency of bowel movements secondary to radiation proctitis?
In the acute setting we try anusol HC suppository to decrease tenesmus like symptoms
How do you optimize HDR brachytherapy for intracavitary treatment of cervical cancer?
We do image based brachytherapy (MRI based). Start with standard weighting for point A dose and there after manually adjust dwell times to get D90> or = 100% and cumultative D2cc for rectum 65 Gy or less, Bladder 80 Gy or less and sigmoid 70 gy or less With weightedd planning, majority of times dose...