Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose and fractionation do you use for definitive radiation for SCC in situ of glottic larynx?
63 Gy/28 fractions larynx only; 93% local control
How do you manage imaging artifacts from surgical staples when planning post-operative radiotherapy for resected brain tumors?
In general, patients I see have their staples removed by the time they come for simulation. That being said, I don't routinely insist they be removed if still intact. I would discuss with my surgeon if there is an indication to keep them longer. If no indication, sometimes I'll just have them stop b...
Is there any data comparing neoadjuvant pancreatic SBRT vs standard fractionation in terms of its ability to convert unresectable tumors to resectable tumors?
Essentially zero%... this patient should be referred to a center that is giving ablative doses. (100Gy BED) or a surgeon that will do a celiac axis resection (Appelby). Alternatively, you should be honest and say low dose SBRT and 50.4Gy /28# have very little to offer him. The LAP-07 trial clearly s...
How long after pancreatic SBRT do you wait to re-image?
Standard imaging interval after preoperative long course radiation has been 5 weeks, by that analogy after a 1 week course of radiation it should be longer but it's an arbitrary decision. The only thing I would avoid is operating in less than 5 weeks because the acute reactions need to resolve. In t...
What rate of second malignancies do you quote for patients receiving radiosurgery for benign CNS tumors?
<1% at 10 years based on following Lancet Oncology paper: https://www.ncbi.nlm.nih.gov/pubmed/30473468
Would you consider PMRT in a patient with N0(i+) luminal A disease?
ITC upfront at this point would not sway decision for PMRT unless it is ITC after neoadjuvant systemic therapy
What dose-fractionation would you utilize to treat a multiply recurrent high-grade urothelial carcinoma of the bladder in a patient who is not a surgical nor chemotherapy candidate?
55 Gy in 20 fractions over a 4-week period like MRC
What is your preferred approach for stage III NSCLC with single station N2 disease amenable to lobectomy?
The question of how to handle operable IIIA patients with limited N2 disease has always been controversial, and the new PACIFIC data just makes it more complicated.At some level, it becomes a duel of unplanned subset analysis and a bit of apples to oranges, which is always to be taken with a grain o...
Do you routinely treat the anterior oblique breast suprclav field with 6MV photons or do you use a higher dose, such as 10+ MV?
In the era of 3D planning to cover axilla and s/c area in breast cancer use of high or mixed energy to cover nodes is very common as they are deeper than what can be covered with 6MV without exceeding hot spots size and volume
What anesthetic spray do you use (if any) for numbing the nasal passages when performing nasolaryngoscopy?
I prefer a combination of an anesthetic mixed with a vasoconstrictor. For the anesthetic component, lidocaine with a potency of 2% or higher will suffice. Phenylephrine or oxymetazoline are the typically available drugs for opening the nasal passages. These can be compounded in a solution by the pha...