Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
With vaginal cuff brachytherapy, do you treat to active or treatment length?
There is no consensus what length to treat. The data for 2 to 5 cm appears to have similar outcomes. We treat 3 cm length so we have 7 dwell positions but as the rectovaginal septum thins out in the mid and lower vagina, the depth of prescription of 5 mm is usually in upper 2 cm or so only. Beyond t...
Is there concern for hemorrhage after SBRT to a lung metastasis that directly involves a branch of the pulmonary artery?
Tricky spot. Are you sure it’s invading the PA or is it just nestled up real close. That would change my answer a bit. I have seen direct invasion of the PA and there’s usually some hemoptysis. It’s a very high pressure system and it usually leaks a little. Those are truly scary and I honestly don’t...
Would you offer PMRT to an ER/PR positive HER2 amplified early stage (node negative) breast cancer patient found to have less than pCR to neoadjuvant TCHP?
With TCHP, expected pCR is rare (around 25 to 30 percen) for ER positive breast ca and they derive benefit from anti estrogen therapy and I would not offer PMRT Only one with node negative but less than pCR would consider for PMRT is triple negative especially if residual disease is more than 2 cm
How do you manage a patient with decreased but residual PET activity following concurrent chemoRT and PCI for limited stage SCLC?
I agree with @Dr. First Last. There are too many false positive PET scans in the mediastinum. There is no effective second line therapy. Only under the rarest of situations would we consider biopsy to prove this is persistent SCLC and consider surgical resection. The best advice I could give would b...
Would you offer scrotal radiation to a patient with a stage IIE bilateral testicular DLBCL treated with a bilateral orchiectomy and chemotherapy?
Bilateral orchiectomy is considered an alternative for those who refuse ISRT to the testicles, so I agree with you that there does not appear to have strong indication for RT in this case. However, there may be a lot of other nuances to this case. I would talk to the surgeon to make sure there was n...
How does the finding of synchronous bladder cancer affect your treatment recommendations for high risk prostate cancer?
We have quite a few pts with synchronous early bladder ca with prostate ca treated with brachy. I have not seen any significant additional morbidity with IV therapy but have not evaluated objectively
Is it appropriate to offer low dose radiation for Hidradenitis Suppurativa that have failed conservative interventions?
We are currently writing about our experience with high dose electron therapy for HS. Low dose therapy was not giving us the results we wanted. The dose needs to be high enough to destroy the sebaceous glands where the chronic infection resides. Our initial treatment is 3 Gy fractions 3 times per we...
Would you treat the supraclavicular nodes electively for a patient with esophageal adenocarcinoma originating in the mid-esophagus but extending above the carina?
Yes, a surgical series using Sclav LN dissection for thoracic esophageal ca showed a 15% Sclav LN +ve rate in mid lesions. Without a contraindication, and assuming patient risk is even higher given extension above carina, I would electively include.
Are there any treatment related considerations in a patient with HIV who is on antiretroviral therapy and receiving adjuvant radiation for breast cancer treatment?
Though I have not recently treated many breast or cervical cancer patients with HIV disease compared to the mid-80s and 90s, yet I still continue to treat prostate and head and neck cancer patients with the disease. In these cases, it has been my experience that if patients are taking their HAART as...
Do you use a chest wall constraint when treating large lung cancers with 8 or 10 fraction SBRT?
There are a few studies that report that the volume receiving 30 Gy correlates to toxicity, and the Kavanaugh paper provides a "rule of thumb" - if 30cc of chest wall receives 30 Gy or more, then there is a 30% risk of severe chest wall toxicity. Dr. Videtic at Cleveland Clinic reports this, as well...