Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you consider the insertion of nephrostomy tubes for gynecologic malignancies without fistulas?
I agree with Professor @Dr. First Last, in addition, bilateral hydronephrosis, cortical thickness intermediate for imminent renal function decline, and treatment (chemoradiation) is planned, nephrostomy tubes can be considered. In some cases, inflammation from radiotherapy (obstructive uropathy) and...
Do you consider a solitary IHC+ sentinel inguinal node lymph node to have the same implication for treatment as a single positive node or multiple positive nodes?
Implication and outcome are different but what intervention is needed is uncertain. In view of Merkel cell histology, would favor adjuvant RT to primary and nodal region.
How would you approach an ulcerative non-melanomatous skin cancer of the lower extremity s/p Mohs surgery with gross disease left behind?
If there is gross disease, then the wound is less likely to heal. Need to explore surgery with flap or RT as definitive management.
Does "preoperative rupture" always necessitate whole abdomen RT for Wilms' tumor?
This is controversial. Theoretical arguments aside, our committee (COG) feels strongly that for any preoperative rupture, whole abdomen RT is required.
For a rectal cancer with questionable T3 or questionable N+ by MRI, can short course radiation be given followed by surgery and the pathology still be interpreted to guide adjuvant chemotherapy?
This is a somewhat common scenario. In these situations, I have strongly favored short course RT followed by immediate surgery such that there is not a sufficient time interval between RT and surgery to allow any significant pathologic response. I think you can be confident in that the pathology aft...
How would you treat an elderly patient with T1 glottic laryngeal cancer who refuses 28 fractions?
I would suggest using 52 Gy in 16 fractions. This is NCCN-supported for T1 glottic lesions and has a long track record of success and tolerability (Gowda et al., PMID 12972304). I have used this regimen exclusively with VMAT. That said, it predates IMRT and 3-D conformal is very reasonable. I would ...
What were the historical radiation fields and dose for treatment of benign tonsillitis?
The majority of patients treated under this indication were children in the late 1940s, 1950s and early 1960s. The prevailing thought at the time was that the irradiation of the tonsils and adenoids would help clear acute and chronic inflammation, and "atrophize" the resultant hyper-plastic lymphoid...
How do you manage grade 3 enterocolitis from 5FU mitomycin and pelvic radiotherapy?
With infection ruled out and CT showing diffuse enterocolitis extending far beyond the bowel-sparing IMRT radiotherapy field, presumably, it is due to the 5FU/mitomycin. In the few cases I have had, it generally heals 2-3 weeks after counts nadir. Besides supportive care (Imodium, Lomotil, Gas-X, ti...
How does a diffusely positive PSMA in the prostate affect treatment planning in a patient with MRI and biopsy showing only one area of disease?
There are three parts to my answer: First, mild to moderate PSMA uptake can be seen in benign conditions, including BPH and prostatitis (e.g., reviewed by Satapathy et al., PMID 32755196). Second, I don't see how the discrepancy between PSMA PET and MRI/biopsy would affect radiation treatment planni...
How would you manage a non-surgical poorly differentiated neuroendocrine tumor of unknown primary with a bulky nodal conglomerate causing pain?
This is a question that could have many reasonable answers. Depending on PS, site, symptoms, and overall onc plan - many standard palliative regimens could be deployed, including more aggressive palliative if this were the only (known) site of disease and more durable local control is intended. Also...