Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Granted adequate target coverage, do you constrain dose to sub-volumes of the heart when treating locally advanced lung cancer?
This is a very important question that recent data is beginning to shed light on. It’s difficult to address cardiac sub-structures without first talking about mean heart dose, its evolution, and the relationship with baseline cardiac risk. While MHD certainly has its limitations, there is a utility ...
Given risks to ADT, do you use it for cytoreduction in low risk and favorable intermediate risk patients prior to brachytherapy or SBRT?
ADT for purely cytoreduction has increasingly fallen out of favor with variable guidelines discouraging the use of ADT solely for this purpose. This is in part because low-risk men should be offered active surveillance now, and unfavorable intermediate and high-risk men generally should be offered A...
Is the skin dose adequate when treating a patient prone for breast cancer?
Good Question! This is how you can approach the issue in any patient position: The skin is not a target in whole breast radiation planning. When contouring breast tissue, typically 5 mm from skin surface is eliminated/deleted when creating this structure. Plan your whole breast treatment after creat...
Do you always use the same CTV and PTV expansions when defining fields for lumpectomy bed boost?
If using electron beams, we expand by 2 to 2.5 cm (based on electron energy) around the lumpectomy cavity. If using photons, then we use 1 cm for CTV and 3 mm for PTV.
Has anyone used radiation to treat a plantar wart not responding to other modalities?
I have treated less than 10 over 30 years. I was taught by my partner in 1990. The best dose is as he taught me: 1,000 cGy x 1. Do not try 500 x 2, which I did only once yielding a painful vesicle even though the two doses were one week apart. Do use surface collimation with 1 cm from block edge to ...
How would you manage a patient with profound dyspareunia after pelvic radiation for anal cancer?
Thanks for bringing up this important topic that remains understudied, with historically widely underestimated incidences of post-radiotherapy dyspareunia. There is currently no standardized method or schedule for assessing post-treatment sexual dysfunction including vaginal stenosis and fibrosis (a...
What is your dose and target for a H3K27M mutant diffuse midline glioma in a young adult following maximal safe resection?
It is important to recognize, that while most H3K27M mutant midline gliomas in young adults are high grade (GBM equivalent), some are actually histologic, more benign tumors (although they tend to occur in other locations). Therefore, a correct histological diagnosis is still necessary. My preferenc...
What is your approach in deciding on definitive therapy for locally advanced, HPV-negative head and neck cancer unsuitable for standard cisplatin based chemo?
The real answer is it depends on the medical oncologist as (s)he typically administers the therapy.It also depends on why cisplatin is contraindicated. Is it an otherwise healthy patient who has renal or hearing issues, or is it an elderly patient with a marginal PS for whom cytotoxics, in general, ...
Would you treat a seminal vesicle only recurrence with XRT in a patient who recieved prior XRT to the prostate but not the SV?
Dr. Anthony D’Amico noted that: "Assuming the rest of the findings are PET (-) and the SV recurrence is bx proven you can consider: You could consider HDR or MRI Linac SBRT (7 Gy x 5)".
What is the optimal work-up for patient with repeatedly negative biopsies of a mid-rectal lesion with signs of malignant etiology?
It is not that rare to get negative biopsies initially in rectal cancer, as superficial tissue only is biopsied. I generally recommend that at repeat biopsies, attempts are made to biopsy deeply to get diagnostic tissue. One approach is to have the surgeons biopsy with a rigid endoscope- they can us...