Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For women who have difficulty healing after a mastectomy but need adjuvant radiation therapy, is there an amount of time for which you would abandon plans for radiation?
While there are data on this topic, there is no clear consensus. Typically, if the patient is not receiving any therapy (ex. post-neoadjuvant chemotherapy patient), I try to initiate RT within 3 months of surgery. On occasion, I have pushed to 4 months but ideally 3 months though, there is some data...
When discussing prostate cancer treatment options, how do you address that surgery side effects are considered acute and radiation side-effects are long lasting?
Stress urinary incontinence as well as ED can last a lifetime after surgery. So, both have acute and late effects. Also since urologists don’t typically (never in my experience) order an MRI prostate, they can expose patients to additional surgical and adjuvant radiation toxicity. If I see a patient...
Would you consider adding adjuvant vaginal cuff brachytherapy for a FIGO 1A endometrial cancer, G1, no LVSI, based on the presence of extensive lower uterine segment involvement?
It’s not an absolute indication for adjuvant brachy with small absolute benefit.
Do you account for dose from previous Lu-177 treatment for definitive prostate cancer treatment?
The short answer is yes. You'll have to assume that the entire bladder epithelium received that dose. However, due to dose rate effects, the equivalent dose to what would be delivered using external beam radiation will be less than 12.8 Gy. You should try to estimate an EQD2 for the Lutathera treatm...
In a patient s/p lumpectomy+RT for an early stage breast cancer, who later has recurrent disease requiring mastectomy and PMRT, under what circumstances would you recommend a boost?
If already had WBI and now requiring PMRT, I only boost for positive margins, inflammatory recurrence, or if skin involvement.
What would be your approach for a patient with triple negative metastatic breast cancer with oligo-progressive disease in the axilla alone?
Would evaluate with breast surgeon. Can consider surgery if other disease stable for > 6-12 mo, followed by +/- RT. Important to consider if primary was already treated and if this is on ipsilateral/contralateral side.
How would you proceed when a cervical cancer undergoing brachytherapy has exceeded the rectal dose but not met the target dose?
Rectal dose and target dose have range. Preferred rectal dose for D2cc < 65 Gy but can accept up to D2cc < 75 Gy, provided you understand expected risk of complications with increased dose. Preference would be to do hybrid applicator with 3D imaging to optimize HRCTV and OAR.
How would you approach a resected solitary osseous plasmacytoma?
With a few exceptions, surgery is rarely pursued as a definitive modality in hematologic malignancies. I have never seen an orthopedic oncologist attempt an oncologic resection for a solitary plasmacytoma of bone, so my subsequent thoughts are theoretical. In the (very unusual) situation posed, if t...
How would you manage a dehiscent vaginal cuff 2 months after vaginal cuff brachytherapy?
It has to be a combination of surgery and radiation. Partial small dehiscence can sometimes be managed conservatively otherwise, most need surgical fixation.
In a patient with favorable risk pT1N0(mic/i+) breast cancer and favorable anatomy, would you use IMPORT-LOW style PBI while incorporating the high axilla?
For N0(i+), PBI is appropriate, I would not include axilla. 40/15, 30/5. If N1mic, would not use PBI but would favor WBI, high tangents if ER+, RNI if ER-.