Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you best palliate metastatic skin and subcutaneous melanoma lesions?
As with most palliative radiotherapy, hypofractionation is appropriate for most melanoma metastases in the skin and subcutaneous tissues. When giving palliative radiotherapy to the skin, it is important to be cognizant of the area of skin being irradiated, and underlying organs at risk. Small areas ...
Has pelvic MRI replaced EUS as the standard of care for rectal cancer staging?
I think looking at data both show very similar sensitivity and specificity for staging and is matter of expertise and resources available at the institution.
For rectal cancer with solitary liver metastasis, do you recommend neoadjuvant chemoradiation?
If the patient is being managed with curative intent (i.e. there is a plan for surgical resection of both the rectal and liver tumors), then preoperative pelvic chemoRT is reasonable for the same reasons it's indicated in the non-metastatic setting. This is a scenario where we often entertain short-...
Is IMRT preferred over 3D conformal RT for lymphoma of the head and neck?
If, based on the location of the node, we can spare the parotid gland more then we would do. The dose response curve for parotid salivary function is sigmoidal and not an all or none phenomenon, which is to say that the mean dose of 15Gy better than 25Gy which is better than 35Gy. As these patients ...
What type of IGRT do you use for external beam partial breast irradiation?
Cone beam CT verification if available.
For patients with high risk prostate cancer, is there data to support increased morbidity, such as increased urethral strictures or cystitis, when given postprostatectomy XRT as opposed to definitive XRT?
This is a very relevant question that commonly comes up in practice - should a man with high risk prostate cancer have a prostatectomy, when the chance of him needing post-op RT is reasonably high, if he could have RT/ADT only and possibly avoid the risks associated with surgery? The discussion must...
How do you treat women who have breast-conserving surgery with positive sentinel node/s and no axillary dissection?
Three separate points to make: 1. Z-11 is often misquoted. The Z-11 trial did not randomize patients to plus or minus nodal radiation. That question was asked in the MA 20 study. In the MA 20 study, as well as a few other studies, the addition of regional radiation provides a meaningful impact on ou...
Do you order a post-lumpectomy mammogram before starting RT?
I get a new baseline mammogram prior to RT in patients who had calcifications associated with their cancer on their initial mammo. This enables me to be sure that all of the suspicious calcs have been removed. I will get this new mammo even if the path shows a neg margin, as pathology is an inexact ...
Should I avoid prescribing lidocaine-containing magic mouthwash to head and neck cancer patients?
The debate on whether to use lidocaine containing "magic mouthwash" was partially fueled by a confusing set of recommendations from the American Academy of Nursing's Choosing Wisely list of 20 things nurses and patients should question. Many radiation and medical oncologists routinely use MMW with v...
Is SVC syndrome a medical emergency?
It is usually not an emergency but rather a medical urgency and all effort should be made to get a tissue diagnosis before treatment. The goal of treatment could be curative or palliative based on the histology, stage of disease, and performance status of patient