Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer scrotal radiation to a patient with a stage IIE bilateral testicular DLBCL treated with a bilateral orchiectomy and chemotherapy?
Bilateral orchiectomy is considered an alternative for those who refuse ISRT to the testicles, so I agree with you that there does not appear to have strong indication for RT in this case. However, there may be a lot of other nuances to this case. I would talk to the surgeon to make sure there was n...
How does the finding of synchronous bladder cancer affect your treatment recommendations for high risk prostate cancer?
We have quite a few pts with synchronous early bladder ca with prostate ca treated with brachy. I have not seen any significant additional morbidity with IV therapy but have not evaluated objectively
Is it appropriate to offer low dose radiation for Hidradenitis Suppurativa that have failed conservative interventions?
We are currently writing about our experience with high dose electron therapy for HS. Low dose therapy was not giving us the results we wanted. The dose needs to be high enough to destroy the sebaceous glands where the chronic infection resides. Our initial treatment is 3 Gy fractions 3 times per we...
Would you treat the supraclavicular nodes electively for a patient with esophageal adenocarcinoma originating in the mid-esophagus but extending above the carina?
Yes, a surgical series using Sclav LN dissection for thoracic esophageal ca showed a 15% Sclav LN +ve rate in mid lesions. Without a contraindication, and assuming patient risk is even higher given extension above carina, I would electively include.
Are there any treatment related considerations in a patient with HIV who is on antiretroviral therapy and receiving adjuvant radiation for breast cancer treatment?
Though I have not recently treated many breast or cervical cancer patients with HIV disease compared to the mid-80s and 90s, yet I still continue to treat prostate and head and neck cancer patients with the disease. In these cases, it has been my experience that if patients are taking their HAART as...
Do you use a chest wall constraint when treating large lung cancers with 8 or 10 fraction SBRT?
There are a few studies that report that the volume receiving 30 Gy correlates to toxicity, and the Kavanaugh paper provides a "rule of thumb" - if 30cc of chest wall receives 30 Gy or more, then there is a 30% risk of severe chest wall toxicity. Dr. Videtic at Cleveland Clinic reports this, as well...
What naming convention do you use when treating multiple brain mets with SRS?
I don't have any special naming convention. I just try to give each metastasis a different name. So if 3 metastases in the L frontal lobe, I might call them L frontal sup, L frontal med, L frontal inf. But this question raises a various serious issue, and that is the confusion that can arise as to w...
Do you offer adjuvant post-prostatectomy radiotherapy to patients with inflammatory bowel disease?
In general, I do not recommend adjuvant radiation for patients with inflammatory bowel disease, even with very high risk features, such as positive nodes. These patients generally have a very long life expectancy, and are at increased risk for long term complications from pelvic radiation. Unfortuna...
What is your preferred treatment for spinal drop metastases from a glioblastoma?
This is a relatively uncommon, but challenging clinical situation, and usually the prognosis is poor. Our approach is as follows: 1. Detailed MR imaging of the spine to ensure that the failure is truly focal, and not multifocal or leptomeningeal: 2. Thorough re-imaging of the brain to ensure that t...
How, if at all, does the presence of hemorrhoidal bleeding affect your radiation recommendations for prostate cancer?
My first quest is to determine what risk group (low/intermediate/high) is the patient in as it relates to the prostate cancer because if it is either of the latter two, ADT will probably be a component of the treatment regime, and this will buy you time to render the afflicted hemorrhoid(s) resolved...