Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend PMRT in a patient with early stage breast cancer who has multicentric disease and close margins?
In early stage breast cancer close margins with multicentricity in itself would not be an indication for us to recommend PMRT unless has multiple other adverse factors like T2, high grade, LVSI and young age.
Do you use a metal biliary stent as a fiducial marker for cholangiocarcinoma?
Yes, I use expandable metal stents as fiducials in pancreas as well as biliary tract cancers. There is no concern for either migration or forward scatter causing complications. Please see discussion in the below letter to the editor. My only concern in the pancreatic patients is that the distal end ...
Do you change dose and fractionation when repeating RT for heterotopic ossification prophylaxis?
In the few I have done I have not changed dose Need to see if it failed because of inadequate field and and make sure at risk area is covered adequately
How are you using the data on cardiac morbidity in regards to the LV-V5 in breast cancer patients?
At present we use MHD as our hard constraints and limit to less than 2Gy for patients with breast only RT. Besides make sure that no part of beam passes through any portion of heart (thus limiting heart dose from scatter and transmission only) Darby data was also validated by similar study from UK w...
How do you manage HPV positive squamous cell carcinoma in situ of the oropharynx?
transoral surgery
In what situations do you recommend preoperative chemoradiation for gastric cancer?
I very rarely use preoperative radiation therapy in true gastric cancer. The data on RT in gastric cancer is mostly postoperative RT. In the past I have used RT for the rare distal lesion that was not resectable without a Whipple to try to convert the tumor to resectable. Even in that situation, I w...
Is there any mature data about cognitive outcomes in 12 Gy vs 18 Gy in the setting of prophylactic cranial irradiation for ALL in children?
There is some data on AML showing some differences between 12 vs. 18 Gy, yet still quite a low incidence.https://www.ncbi.nlm.nih.gov/pubmed/214804694/134 (3%) of patients treated with 12 Gy versus 8/108 (7%) of patients treated with 18 Gy demonstrated behavioral disorders and cognitive impairment. ...
Would you recommend a cycle of chemotherapy prior to concurrent chemoradiation for a Stage III NSCLC patient who needs to start treatment sooner than allowed by the IMRT planning process?
For a patient who has symptomatic airway disease requiring urgent intervention, they should be stabilized with airway stenting and high-dose steroids to allow time to generate a good IMRT plan. Induction chemotherapy has no guarantee of improving symptoms and has been shown in the CALGB study (Vokes...
How do you approach SRS reirradiation for brain metastases overlapping previous sites of SRS?
This situation has several variants. First of all its incidence should be about 5% in most SRS cases. Second all retreatment decisions should be made following co-registration of current images with treatment images. Easy to be tricked based on scan angle. Variant 1: Response followed by recurrence ...
How does pelvic radiation impact a patient with a known iIliac aneurysm?
I have done few patients and have not changed management or RT dose based on aneurysm. I do tell patients we don’t know the long term effect but have not seen any early complications.