Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you routinely screen for pituitary dysfunction after radiation therapy for nasopharyngeal cancer?
I don’t, only if symptoms
How do you counsel young and educated patients with non-metastatic breast cancer who choose non-proven "natural" treatments over standard therapy?
It is extremely difficult to persuade individuals skeptical of medicine to make evidence-based decisions. Most research related to changing scientific beliefs come from literature related to antivaccination attitudes. Previous research has suggested that provaccine messages about safety (messages co...
If a man has been on a 5-alpha reductase inhibitor for urinary symptoms prior to prostate radiation therapy, is there value in continuing it after radiation therapy?
5-alpha reductase inhibitors, e.g. dutasteride, are indicated for the treatment of symptoms related to BPH and an enlarged prostate and have some efficacy for this indication, especially when combined with alpha blockers. 5-alpha reductase reduces a double bond in testosterone to create a more poten...
What has been your institutional or personal experience with the Venezia or other hybrid interstitial brachytherapy applicators?
I have used both Vienna and Venezia applicator. Venezia is easier to use because of the split ring (easier to insert) and has more flexibility to treat lateral parametria disease or distal vaginal extension which cant be done with Vienna. One needs to be cautious about post procedure bleeding becaus...
What is the optimal timing of adjuvant chemotherapy and radiation for a young adult with a grade II oliogodendroglioma?
RTOG 9802 provides a substantial amount of data necessary to answer this question. In patients with residual disease following resection of a G2 oligodendroglioma, I tend to recommend RT and PCV chemotherapy (with my bias being to favor RT prior to PCV).RTOG 9802 is one of the very few randomized tr...
How do you manage a stage I LLL medically inoperable lung cancer in close proximity to the stomach?
This is a rare but not uncommon problem (or maybe unusual but not infrequent...). There’s a couple ways to approach this, depending on the tools in your department‘s toolkit. These low lying LLL lesions are ones that I always treat with breath hold (or gated if you have that). You could also look at...
Do you take into account the dose calculation algorithm used when selecting a prescription dose?
I was asked to forge an answer for this one and it’s a little beyond my knowledge base so I queried a colleague here and am enclosing his very excellent response. The physicist who wrote this (who wanted to remain nameless, so lets call him MedPhys NOS) has spent a fair bit of time working on these ...
How do you approach breast cancer treatment planning for patients with tissue expanders that have magnetic valves or metal ports?
the influence of the device with tangential beam is small. see attached dosimetric data using monte carlo calculationshttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055430
How would you manage an axillary lymph node only recurrence after prior mastectomy, chemotherapy and hormone therapy?
In setting of no previous radiation therapy and axillary dissection for recurrence, I would recommend comprehensive radiation to chest wall and regional nodes including SCV/Axilla. I would consider inclusion of IMNs based on pathologic and patient factors.
How do you treat radiation myelopathy?
The short answer is "I don't really know what the optimal management is for radiation myelopathy" (fortunately I don't have much experience with managing this.) Since it is very rare, I would first suggest that you be clear about the diagnosis. It is a diagnosis of exclusion, but beware that other e...