Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage metal dental fillings/prosthetics and hot spot concerns for head/neck radiation?
We use a devise we call "teeth guard", made of polyvinyl siloxane putty described in an article by Ben David M et al. It has a thickness of about 5 mm, which is the typical range of the secondary electrons scattered off metal in the teeth, to reduce hot spots in the gums and tongue. The device and i...
Do you perform a bone health assessment in men who will be receiving short term androgen deprivation for localized prostate cancer?
I do not order bone densitometry on patients I am treating with short term (<= 6 months) of AD, unless they have a risk factor like long-term glucocorticoid use or prior fracture. For patients I am treating with long term >=18 months I perform a baseline bone densitometry. If that is normal-mild ost...
Is there a role for treating actinic keratosis with superficial radiation therapy to widespread areas on scalp?
No.
Would you consider treating the regional nodes in addition to the breast in a patient with skin involvement (pT4b) after a lumpectomy with negative margins/nodes who refuses chemotherapy?
I can't say that this is a commonly encountered scenario. It's tough to imagine the T4 patients that's a good upfront BCT candidate. In my opinion, it is very reasonable to consider RNI in a high risk node negative patient. High risk N0 patients were included in MA.20 and EORTC 22922 and derived sim...
Would you recommend PMRT in a patient with a microinvasive component but a large DCIS component who had a mastectomy with negative margins?
Patients with DCIS treated with mastectomy and negative margins wouldn't get PMRT, so this patient wouldn't either. Essentially, they have an extensive intraductal component, and EIC with negative margins is not a risk for recurrence, thus PMRT would not be warranted.
For patients you treat with LDR prostate brachytherapy, how do you sequence treatment with external beam radiation therapy?
We use EBRT followed by LDR brachytherapy in 3-4 weeks time
What interventions besides lubricants do you advise to improve sexual satisfaction for patients s/p ChemoXRT for cervical cancer?
Advise a multimodal approach Additional strategies: 1) Vaginal dilator therapy. Additional visits outside of follow-ups may improve adherence 2) Vaginal moisturizers - Replens, Vitamin E oil, etc. This is outside of water-based lubricants during sexual activity 3) Topical estrogens (many of these pa...
How to you account for motion when contouring head and neck primaries in more mobile areas such as base of tongue and larynx?
We instruct our patients not to swallow during the CT simulation. We do not account for organ motion when contouring. The duration of intrafraction swallowing during the entire course of conventional RT has been reported to be small, at 0.43% of the total irradiation time (1). van Asselen B, Raaijma...
Would you recommend pre operative (chemo)radiotherapy for a patient with a T3 N0 low rectal cancer in a patient with active Crohn's disease?
Personally, I would not recommend neoadjuvant radiation therapy. Assuming the patient is a candidate for FOLFOX chemotherapy if appropriate after surgery and pathological staging, the benefit of radiation is probably a single digit decrease in local failure. Pelvic recurrences are terrible, and that...
Is postoperative radiotherapy indicated for a 5 cm grade 2 synovial sarcoma of the knee joint?
Our approach is to treat with adjuvant radiation for any grade 2 or 3 sarcoma; thus even in this case, I would recommend treatment.I would consider smaller margins per the VORTEX trial (abstract https://www.redjournal.org/article/S0360-3016(16)30347-9/abstract ) and if wide margins would treat to 60...