Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is an acceptable SBRT dose for a central lung cancer encasing a coronary artery bypass graft?
As a Minnesotan, my immediate reply to your problem is "uff da, that's a tough one eh?". An image of the tumor location would really help here, but I'm going to presume it's maybe off the subclavian artery (longer course and may have more lung surrounding)? Either way, your patient is in a tough spo...
Does the literature support a benefit for whole lung irradiation for high risk rhabdomyosarcoma with multiple lung metastases?
My opinion is that there are no direct data. The European investigators are talking about doing a randomized study to investigate the value in intermediate risk patients. In US it has been standard for stage 4 pulmonary cases with RMS since WLI was established for patients with Ewings Sarcoma in IES...
In the modern IMRT/SBRT era, what should be the appropriate definition for the term "hot spot" in evaluating a plan?
The dose heterogeneity with IMRT has improved significantly over last 15 years. In past it was not unsual to see point hot spot (.03 cc) of 120% in PTV with a significant volume of PTV getting 110% or more.In modern planning with improved software and hardware usally point hotspot in majority of cas...
Would you treat the whole brain for brain metastases in a patient with active systemic scleroderma?
Any intervention which we do , we have to weigh pros and cons of treatmnent. For patients with brain metastases if untreated has worse acute consequences with potential neurodeficit vis a vis potential for late morbidity because of scleroderma. If feasible would do radiosurgery and if required would...
At what PSA do you start calculating doubling time post-prostatectomy?
The problem you describe, I think, also applies to standard assays when values are at or near the limits of detectability. Is an increase from 0.1 to 0.2 in 3 months really indicative of a rapid rise? If you are seeing small changes at low PSA values, and you're not inclined to treat the patient, yo...
How do you manage high risk prostate cancer patients with well controlled Crohn's disease?
My first choice would be to manage them without the use of radiation therapy. A minority of patients with high risk disease are curable with surgery, and the population with inflammatory bowel disease is one that I tend to steer away from radiation therapy. Despite the adverse prognostic features of...
How do you perform geriatric assessment for cancer patients?
This is a HUGE topic. I would like to suggest the following 2 resources that you may find helpful. https://www.mycarg.org/?page_id=898 and the following one helps predict residual life expectancy independent of cancer diagnosis: https://eprognosis.ucsf.edu
How long should the duration of hormones be in post-prostatectomy patients receiving salvage RT?
That depends upon why you are giving the ADT. If you think it is just to improve local control in the prostate bed then 6 months should be more than enough. If it is to address micrometastatic disease, then to be consistent with other precedents, it should be two years. An RTOG trial looking at salv...
What dose and upper field border would you use following transanal excision for rectal cancer found to be T2 by final pathology but without LVSI or perineural invasion?
So this is a rectal adenocarcinoma that was was locally excised and found to be T2 with no otherwise concerning pathologic findings. I use S.P. Bach et al (British Journal of Surgery 2009; 96: 280–290) to estimate risk of LF with no further therapy. The Bach paper is a report of the British TEM regi...
How do you taper steroids for patients with symptomatic edema following standard chemoradiation for GBM?
I agree with above and would add that decreased production of corticosteroids by the adrenals does not typically occur until after a patient has been on steroids for at least 3 weeks. If you have a patient on steroids for less than this time period I suggest a rapid taper that is based on symptom co...