Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you routinely re-image all craniopharyngioma patients during radiotherapy?
Yes, typically weekly. Ideally with MRI. HASTE MRI is often sufficient. If the cyst wall has enough calcifications and MRI authorization is a challenge, I will sometimes substitute a CT head (often as a re-sim using the treatment mask).
Which pathologic features do you use to determine VCB vs pelvic RT in Stage IA/IB endometrial patients in the era of Sentinal Lymph node Biopsy?
The decision for adjuvant treatment type for us is based on similar pathological features for node negative endometrial cancer whether node negativity is based on SNL or dissection or sampling Recent randomsied study shows 99% negative predictive value in patients in whom sentinel node is identified...
How do you factor environmental or occupational radiation exposure in counseling or planning for radiation therapy?
I don't think I would counsel not to receive XRT, only that there *may* be increased risks (but the data is conflicting). Quoting Hall, "In the past 50 years, there have been a number of accidents in which small numbers of persons employed in the nuclear program were exposed to total body or partial...
In the era of MRI and other advanced imaging, do you still routinely perform a digital rectal exam on every prostate cancer patient?
Having started my career in the era when the latest in advanced imaging was a first generation CT scan, I still perform DRE on every patient at consultation (unless they refuse). There are several reasons for this approach. First, the information you get from DRE is needed for staging purposes, whic...
What is your approach to managing patients with medically inoperable early stage endometrial adenocarcinoma who also cannot tolerate intracavitary brachytherapy (Rotte-Y, etc) as boost?
The curative-intent treatment of medically inoperable patients can be clinically challenging. Treatment is best individualized, taking into account their comorbidities, severity of disease, and other factors. Inoperability (unsuitable for hysterectomy) is largely due to serious medical comorbiditi...
How does your department manage scheduling surrounding holidays?
The impact of treatment prolongation on local control has been well established for cervical cancer and squamous cell carcinoma of the the head and neck, presumably due to the phenomenon of accelerated repopulation. At University of Minnesota, we make every effort to minimize unplanned treatment bre...
What is appropriate local salvage therapy after prostate brachytherapy failure?
I would not re-irradiate the prostate using EBRT. I would only use HDR brachytherapy. I would give 6Gy x 6 /2 implants based on our published experience. Alternative fractionation is 8Gy x 4 based MSKCC study. There is also data on permanent seed salvage. That is mostly for post EBRT failure. Howeve...
What do you recommend if you find persistent lymphadenopathy during CT simulation for adjuvant head/neck radiation therapy?
Assuming the simulation was performed in a timely manner (within 3-5 weeks post op), in the majority of cases this would be considered an early recurrence despite an adequate neck dissection (min 15-20 nodes), and requires intensified salvage (rather than adjuvant) treatment. Addition of chemo/syste...
In what situations, if any, do you offer postoperative radiation or chemoradiation for patients with squamous cell carcinoma of the esophagus?
While in the US/ Europe, the overwhelming approach for ESCC is neoadjuvant chemoradiation +/- surgery (our institution uses surgery only for incomplete response to chemoradiation based on the German/French data), in Asian countries, where the relative percent of squamous cell carcinomas is higher th...
What do you consider a radiation oncology emergency?
I like this question. There are the classic ones that we've all treated in residency and since then: 1. Spinal Cord Compression (Obviously). 2. Intractable bleeding, particularly in GYN cases, though packing should be applied as well. 3. Intractable pain with a clear cause by tumor structure. 4. Rap...