Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should pre-pectoral implants be avoided for reconstruction in breast cancer patients out of concern that it may mask local recurrences?
None of outcome data has shown that having reconstruction with impant or autologous flap has increased or delayed the diagnosis of local recurrence. Some of it could be explained based on site of recurrence which is usually superficial to pec muscle. The publication by us outlines sites of local rel...
What is your approach for, and in which situations would you use, an external boost in the management of gynecologic cancers?
The most important and consistent indication for external boosts is in the treatment of regional disease. In nearly all cases where there is evidence or suspicions of gross nodal involvement, we treat the sites of gross disease to at least 60 Gy, while areas of microscopic disease typically receive ...
When would you offer adjuvant RT after R0 resection for a distal esophageal adenocarcinoma?
Before I would offer adjuvant postoperative radiation therapy I would need to see a clear risk factor for local recurrence and a clear anatomic site to irradiate. One of the reasons that preoperative radiation therapy is so much more attractive in this disease than postoperative therapy is that it c...
In a patient with a large condyloma adjacent to a squamous cell carcinoma of the anal canal being treated with chemoradiation how would you incorporate the condyloma in the target volume if it is PET negative and would it receive a different dose?
I do not entirely agree. First, I do use PET scans in anal cancer as I am very concerned for metastatic disease if there are PET positive nodes, regardless of the CT size. This is not so useful in the groin where there can be inflammatory nodes that are PET positive. However, I change my doses and f...
Is there a role for hyperbaric oxygen treatment concurrent with radiotherapy in the treatment of pediatric glioblastoma?
HBO has been used primarily in the treatment of radiation induced injury in patients with controlled intracranial disease. The application of HBO in the post-treatment setting has been limited by fears of latent reactivation of tumor metabolism and therefore progression. There are countless manuscri...
What margin do you give around the internal mammary vessels when treating IMN nodes for breast cancer?
I typically use 8mm-1 cm around the vessels, excluding sternum and lung. I contour the vessels in the 1st-3rd intercostal spaces. MA20 used 1 cm around the vessels with coverage by the 80% IDL. The only exception to this approach is if patients had radiographically enlarged internal mammary nodes. I...
How do you approach disease monitoring in patients with localized rectal cancer who have received treatment with chemoradiation?
MRI can provide useful results about tumor stage before and after re-operative chemoradiation. If tumors show a good response to chemoradiation this is a good prognostic sign. For tumors that are initially very large, another reason to do an MRI after chemoradiaiton is to see if the tumor is surgica...
What techniques do you use to treat patients who weigh more than the treatment table limit?
In our institutional experience, this weighty question arises more often than we would prefer and most commonly for cervical cancer patients. If the patient is only nominally beyond the limit, it is important to consider that the weight limits are consequent to the tolerance parameters of the motors...
How do you handle pregnancy testing for women of childbearing age?
When ordering a simulation we denote whether a pregancy test is needed. If so, it is performed before the simulation takes place. Department policy dictates that all women of childbearing age have a serum pregancy test before the simulation CT scan (excecpt those unable to get pregnant, for example ...
What adjuvant therapy (chemotherapy, radiation) do you recommend for incidentally found focus of small cell prostate cancer at time of radical prostatectomy?
This is an interesting question. Extrapolating from the relatively recent data on surgery for early SCLC, the local therapy for an incidental focus of small cell histology has been completed after RP. If there is tumor that penetrated through the capsule, I'd look at the amount of tumor that broke t...