Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the optimal timing of adjuvant chemotherapy and radiation for a young adult with a grade II oliogodendroglioma?
RTOG 9802 provides a substantial amount of data necessary to answer this question. In patients with residual disease following resection of a G2 oligodendroglioma, I tend to recommend RT and PCV chemotherapy (with my bias being to favor RT prior to PCV).RTOG 9802 is one of the very few randomized tr...
Do you take into account the dose calculation algorithm used when selecting a prescription dose?
I was asked to forge an answer for this one and it’s a little beyond my knowledge base so I queried a colleague here and am enclosing his very excellent response. The physicist who wrote this (who wanted to remain nameless, so lets call him MedPhys NOS) has spent a fair bit of time working on these ...
How do you approach breast cancer treatment planning for patients with tissue expanders that have magnetic valves or metal ports?
the influence of the device with tangential beam is small. see attached dosimetric data using monte carlo calculationshttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055430
How would you manage an axillary lymph node only recurrence after prior mastectomy, chemotherapy and hormone therapy?
In setting of no previous radiation therapy and axillary dissection for recurrence, I would recommend comprehensive radiation to chest wall and regional nodes including SCV/Axilla. I would consider inclusion of IMNs based on pathologic and patient factors.
How do you treat radiation myelopathy?
The short answer is "I don't really know what the optimal management is for radiation myelopathy" (fortunately I don't have much experience with managing this.) Since it is very rare, I would first suggest that you be clear about the diagnosis. It is a diagnosis of exclusion, but beware that other e...
How do you treat pleomorphic rhabdomyosarcoma in an adult?
Rhabdomyosarcoma is a rare malignancy, with ~350 cases annually in the United States, but most commonly occurs in children. Thus, adult rhabdomyosarcoma is exceedingly rare. As a result, there are very limited data on adult rhabomyosarcoma to guide treatment decisions and much is extrapolated from t...
How do you manage dry mouth after head and neck RT?
I think it is important to very clearly explain to the patient that xerostomia is common and even should be expected, even in the era of highly conformal treatment plans. If a patient is highly motivated to preserve saliva, pilocarpine can be used concurrently with radiation where it has been shown ...
For what patient groups (if any) do you routinely recommend screening colonoscopy prior to radiation for prostate cancer?
As a cancer care provider treating both GI and GU malignancies, I see this as a commonly. In many healthy men, an elevated PSA may be what allows them to "plug in" to the American health care system, often the first time in many years. Considering most prostate cancer is detected by an elevated PSA,...
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 ...