Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you hold anticoagulation prior to prostate brachytherapy?
Yes, but always per the patient's cardiologist's recommendation. Also not even after the designated time for withholding meds may still be anti coaged so we get pt/ptt morning of the procedure.
How would you approach a patient with low grade follicular lymphoma (stage IE) of the breast who presents with local recurrence 1 year s/p lumpectomy?
I would re-stage the patient with imaging. If the disease remains localized, then I would treat with definitive RT (24-30 Gy in 2 Gy fractions using ISRT principles). It would be interesting to look back at the pathology from the original lumpectomy. Unless margins were widely negative, I would prob...
How do you risk stratify patients with MRI guided prostate biopsies?
If the patient has had standard template biopsies and targeted biopsies, I only consider that standard biopsies in the quantification of the proportion of cores involved since the data used to derive the prognostic significance of this feature was based on standard template biopsies not targeted cor...
Would you offer radiation therapy post lumpectomy for a small melanoma oligometastasis with negative margins?
I don’t know if RT will have benefits for melanoma with negative margins.
How, if at all, does your approach to adjuvant chemoradiation differ with proton beam radiation vs. conventional photon radiation for H&N Cancers?
As there is no prospective data for protons over photons in head and neck cancer, despite the proliferation in utilization, I would not feel comfortable treating this way unless it was the only option.In addition, recent reports indicate a relatively high risk of mandibular ORN, which is hardly seen...
Does acute radiation cystitis cause microscopic hematuria and pyuria?
Radiation cystitis is the diagnosis.
How do you approach a urethral carcinoma s/p non-oncologic resection?
I have treated a few of them. It usually tends to be clear cell histology. For a non oncologic resection, I treat with chemo RT and have had mixed results.
What criteria do you use to determine the resectability of mucosal melanoma of the H&N region?
Obviously, the best specialist to answer the posted question would be a H&N surgeon. As a Rad Onc enthusiast who conducted a retrospective study about the subject long ago (Lee et al., PMID 8302112), I’ll provide my own 2-cents here:Mucosal melanoma (MucMlnm) of the H&N is a relatively uncommon mali...
Do you have any precautions to your injury to the uterine artery when placing interstitial needles as ‘ovoid extenders’ to cover parametrial disease in cervical T&O procedures?
When using oblique needles, it does come close to parametrial vessel, and the risk of bleeding is increased. Some use Doppler ultrasound to identify and avoid needles in vessels. What we do is tend to usually not push the oblique needle beyond 2 cm and adjust later on CT if needed and take precautio...
How do you approach hormone replacement therapy for premenopausal patients following pelvic radiation therapy?
Most patients who undergo pelvic radiation will become menopausal. Physiologically, the outcome is similar to surgical menopause because sufficient doses of radiation result in complete loss of ovarian function. In contrast, after natural menopause, the ovaries continue some types of endocrine funct...