Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When would you recommend hyperbaric oxygen treatments for skin ulceration/non-healing wounds in a radiated field?
I agree with @Dr. First Last' answer. Careful planning and attempts to avoid non-healing wounds is important, but this can happen. Conservative management should be used before hyperbaric O2 except for severe toxicities such as radiation optic neuropathy where all reasonable measures should be consi...
How do you counsel a patient with breast cancer and a rad50 mutation when deciding between lumpectomy and radiation vs mastectomy?
There are currently no data suggesting that a heterozygous RAD50 mutation is associated with increased clinical risk of radiation toxicity and I would not alter treatment options based on this information. While it is a DNA repair molecule, this does not de facto indicate a risk for radiotherapy. BR...
Would you recommend APBI in a suitable candidate if they have pre-existing breast implants?
I have not done it but there is good data of using interstitial brachy for APBI in these patients from Dr Kuske. I have used SAVI and there are reports of using SAVI device as they can be used for small cavity which most of these patients have. I can cover the prescription isodose line up to the cap...
How do you talk to patients about clinical trials?
I try to incorporate the clinical trial idea into the standard of care recommendation/discussion at the time of initial treatment decision making. After making a standard of care rx recommendation, I tell patients that my recommendation is based upon this treatment being the winner of a prior trial ...
Do you take any precautions in planning PMRT for patients who had taxane-induced pneumonitis?
The data regarding increase risk of radiation pneumonitis with Taxoil chemotherapy was more of a timing than lung volume issue. This risk was extremely high (>15%) when RT was given concomitant with radiation in the early days and also when it started close to the last cycle of taxol. We have notice...
What factors other than resection status (R1,2) do you consider when offering adjuvant chemotherapy for patients with thymic carcinoma, and how do you coordinate with post-op radiation?
I do not routinely recommend adjuvant chemotherapy for patients with resected thymic carcinoma as there is no data that this improves outcome. If not an R0 resection, then we recommend post-operative radiation therapy.
How does a sentinel lymph node biopsy versus nodal dissection affect your treatment decision for Stage II endometrial cancer?
For stage II endometrial cancer, pelvic relapses can be at cuff, node and parametria. So if type I hysterectomy is done we favor EBRT unless all factors are favorable and stromal invasion is limited to inner 1/3 rd ( superficial )https://www.ncbi.nlm.nih.gov/pubmed/28866431
What dose would you treat a patient to for a positive deep skeletal muscle margin after mastectomy who is not a candidate for re-resection?
I would offer PMRT and boost the area of positive margin to 60-66 Gy based on pre op imaging and extent of positivity seen on pathology
Does HIV/AIDS change your management of locally advanced NSCLC?
Those with negative viral load and CD-4 counts > 500 are just like HIV negative. Non compliant, Low CD4 and fluctuating viral loads at risk for toxicity of treatment. For CD4 < 200, I would not use concurrent therapy. Perhaps sequential. Maybe XRT alone. Many have not used anti-retrovirals consisten...
Does external iliac coverage, such as in a T4 primary, justify IMRT for rectal cancer?
In training, I was taught that IMRT may be justified in rectal cancer with T4 disease, because a greater volume of bowel was treated when the field was extended anteriorly, and that seems to make sense. Overall, more people are using IMRT for rectal cancer patients, but it doesn't seem to coincide w...