Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Aside from ECE or positive surgical margins, when (if ever) would you offer post-operative chemoradiation in patients with squamous cell cancer of the head and neck?
Aside from ECE and positive margins, we also offer postop chemoRT to oral cavity cancer with MULTIPLE risk features: for example, a combination of the following: large tumor, bony invasion, close margins, PNI and LVI. We feel oral cavity cancers are more aggressive and have much worse prognosis if m...
Do you utilize urethral catheterization at the time of simulation for prostate SBRT planning?
The need for a urethral catheter at simulation depends somewhat upon your dosing technique/strategy, and also whether a planning MRI is obtained. The reason for this is the need for a catheter to precisely define the location of the urethra depends on whether there will be dose sufficient to cause i...
What is an appropriate dose for definitive radiation of a stage IE EBV+ polymorphic B-cell lymphoproliferative disorder?
This is a very unusual presentation for EBV associated polymorphic B-cell lymphoproliferative disorder as most cases are seen in the post-transplant or other immune-compromised patients. In immuno-competent patients, this condition is felt to be related to immune senescence. The range of clinical be...
If a patient develops intermittent painless hematuria during standard prostate RT do you attribute this to cystitis or would you work it up further?
While acute mucosal deepithelialization may be to blame, painless hematuria may unfortunately mark the beginning of a conundrum. It's good medicine to always develop a broad DDx and remember that radiation injuries are waste basket diagnoses. It's also wise to start with a UA/UCx, and if negative do...
What dose and fractionation is safe to use for palliation of a large pelvic mass several years after definitive prostate brachytherapy?
The prescription, technique and modality would depend on histology, size and involvement/distance from organs at risk. At our institution we have often utilized high-dose spatially fractionated radiation therapy (GRID) for large tumors followed by a traditional hypofractionated palliative RT regimen...
How would you approach a biopsy proven NSCLC patient with mediastinum negative disease and contralateral suspicious spiculated PET avid nodule without pathologic diagnosis?
This is a scenario I have faced before. Sometimes unfortunately in spite of staging studies, the stage a lung cancer patient has might remain a bit unclear. In this situation if this is a functioning patient with good PFTs who is a surgical candidate I would consider treating him like he has 2 separ...
Do you alter definitive treatment recommendations for oropharynx p16+ cancers based on the new staging?
As you know, the new 8th Edition of the AJCC staging manual redefined prognostic staging for p16/HPV-positive tumors. It is important to note that p16/HPV is therefore not a PROGNOSTIC marker but rather a DIAGNOSTIC biomarker of a different disease entity entirely. The 8th Edition system is based of...
Does size influence your decision making for women with low or low-intermediate risk endometrial cancer after hysterectomy?
In otherwise low risk disease where I would favor observation, I do discuss pros and cons of adjuvant cuff brachytherapy if size greater than 2.5 cm or so.
When is adjuvant radiotherapy recommended for a high risk squamous cell carcinoma of the skin (non-H&N) if the tumor is resected with widely negative margins and there is no perineural invasion?
There is limited high quality evidence to guide management of "widely" excised cutaneous squamous cell carcinomas. There is an excellent prospective study reporting the outcomes of margin-negative excisions using techniques similar to Mohs surgery suggesting that there are several risk factors for l...
How long after surgery would you no longer offer adjuvant postoperative treatment for head and neck cancer when a patient (with multiple adverse features that needs adjuvant treatment) keeps postponing the start of radiation?
Ultimately, I feel this depends on why the patient keeps postponing treatment. If there are legitimate medical reasons for delay, I would not have a cutoff for starting adjuvant RT at any time - even several months after surgery - as long as the patient can tolerate curative-intent therapy and I hav...