Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you advise a woman who had a full axillary lymph node dissection on the risk of lymphedema with mountain climbing?
Well, this is obviously a question with no evidence based answer. Overal, the risk of lymphedema after axillary LN dissection is around 20-25%. Most likely these patients will receive regional LN radiation (due to positive LN's) and the risk will increase to 25-30% (Warren et al). Other risk factors...
How do I convince urologists to send patients for a discussion of adjuvant radiation after prostatectomy?
Howard's advice is spot on as usual.For the residents and even faculty reading this, I think there has been an unnecessary rivalry between radonc and uro-onc that predominately only negatively impacts patients. We are a team and I think if we approach the care of our patients as a team we will provi...
What is your approach to the use of carmustine wafers for glioma patients?
There is no advantage over current therapies.
What kidney dose constraints do you use for extended field radiation for cervical cancer using VMAT or IMRT?
We follow principal of ALARA. If there is no nodal disease close to kidney, then with VMAT we use 16 Gy to 5% or less as our constraint.
How would you treat a synchronous anal and oropharyngeal squamous cell carcinoma?
Whenever i am faced with a patient with synchronous malignancies i like to start by thinking about the two independently. In this case I'll assume that chemoradiation is a reasonable option for both tumors and that the oropharyngeal could also be treated with surgery. In my opinion, the difficulty ...
How would you manage a patient with a h/o HSIL & VAIN3 and recent colposcopic vaginal biopsies "highly concerning for exophytic pattern squamous cell carcinoma" refusing vaginectomy?
I have treated with image guided brachy. I use MRI for planning and a multichannel cylinder. Our dose is 6Gy x 5 or 7Gy x 5 prescribed to thickness of vagina seen on MRI, (varies across length) respecting doses to critical organs.
What factors do you use to decide between phase based vs. amplitude based gating for lung SBRT?
We have not used amplitude-based gating treatment for several reason, most notably for the consistency & reproducibility of delivery. Some patients also have some trouble with amplitude-based approaches as well. Having said that, in our experience, phase-based treatments often allow for a shorter ti...
In light of the recently published CARMENA trial, is there still a role for cytoreductive nephrectomy in metastatic RCC patients?
Several features of CARMENA make the data not applicable to all mRCC patients with primary in place. These include a large percentage of poor risk/poor PS patients, lack of receiving intended protocol therapy, including delayed nephrectomy in almost 1 of every 5 patients, and a primary tumor burden ...
When treating younger men with anal cancer do you consider dose to the prostate?
Given the proximity of the prostate to a typical anorectal target volume, it would be difficult to completely spare the prostate without increasing the risk of a marginal miss. I would not recommend compromising target coverage to spare the prostateClinical concerns about prostate dose could involve...
How do you manage vaginal dehiscence discovered during vaginal brachytherapy?
You need to withdraw the applicator and keep patient supine. The patient will require admission and emergent surgery to fix the defect, otherwise bowel loops may prolapse through the defect.