Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What types of sexual side effects do you discuss with men undergoing radiation therapy for rectal and/or anal cancer?
This is an excellent question as the literature is pretty clear sexual side effects of non-gynecologic or prostate cancer therapy are often omitted from discussion before therapy or in follow-up. Consequently, there is limited data on sexual dysfunction for rectal or anal cancer survivors. The studi...
What imaging surveillance do you do after SABR of oligo lung metastases?
Since these are metastatic patients I would recommend chest CT scans every 3-4 months for the first and second years. Abdomen and pelvis CT scans could also be done depending on the patient and their disease. I do not recommend PET-CT after SBRT for lung metastases or after SBRT for lung primaries. ...
How do you counsel patients in regards to the options and risks for salvage lobectomy/wedge after SBRT?
For early stage lung cancer, we discuss with our patients the surgical and nonsurgical options, and provide the rationale for our recommendation. A common question is whether the patient can have surgery if the SBRT doesn't work. I think SBRT patients need to know two things relating to this questio...
When do you consider neoadjuvant chemotherapy prior to definitive chemoradiation for cervical cancer?
Although we are occassionally referred patients for "consolidation" of loco-regional disease after favorable responses to chemotherapy for stage IVB disease, we very rarely give neoadjuvant chemotherapy for patients with stage I-IVA cancers with nodal disease confined to the pelvis and PA regions. E...
Do you ever recommend PORT or chemoRT rather than chemotherapy alone for NSCLC with adverse features other than positive margins or N2 disease?
Despite the numerous limitations of the PORT meta-analysis, and subsequent non-randomized studies of postoperative RT in NSCLC, one message seems clear (at least to me)- radiation therapy can cause harm. In patients with resected lung cancer (who often have many co-morbidities), prudence seems a wis...
How do you apply bolus and confirm daily air gaps/setup for vulvar cancer, especially for larger, fungating lesions?
For me, I am into "wet cotton gauze" wrapped in (new) plastic wrapping daily....for it is more conformal than even the old paraffin wax molds I used to use back in the day. Clearly, it is at best a 'guess-ti-mate' as to the thickness required for each case. But it does and has worked well in my expe...
With vaginal cuff brachytherapy, do you treat to active or treatment length?
There is no consensus what length to treat. The data for 2 to 5 cm appears to have similar outcomes. We treat 3 cm length so we have 7 dwell positions but as the rectovaginal septum thins out in the mid and lower vagina, the depth of prescription of 5 mm is usually in upper 2 cm or so only. Beyond t...
Is there concern for hemorrhage after SBRT to a lung metastasis that directly involves a branch of the pulmonary artery?
Tricky spot. Are you sure it’s invading the PA or is it just nestled up real close. That would change my answer a bit. I have seen direct invasion of the PA and there’s usually some hemoptysis. It’s a very high pressure system and it usually leaks a little. Those are truly scary and I honestly don’t...
Would you offer PMRT to an ER/PR positive HER2 amplified early stage (node negative) breast cancer patient found to have less than pCR to neoadjuvant TCHP?
With TCHP, expected pCR is rare (around 25 to 30 percen) for ER positive breast ca and they derive benefit from anti estrogen therapy and I would not offer PMRT Only one with node negative but less than pCR would consider for PMRT is triple negative especially if residual disease is more than 2 cm
How do you manage a patient with decreased but residual PET activity following concurrent chemoRT and PCI for limited stage SCLC?
I agree with @Dr. First Last. There are too many false positive PET scans in the mediastinum. There is no effective second line therapy. Only under the rarest of situations would we consider biopsy to prove this is persistent SCLC and consider surgical resection. The best advice I could give would b...