Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there evidence that radiation therapy can cause a flare in cancer antigens or other biomarkers?
I have noticed with limited experience and elevation of CA 125 during RT for localized recurrent ovarian cancer which has settled down to normal after completion of RT. Could be because of release of antigen caused by tumor breakdown.
How do you manage intractable hiccups from radiation?
Hiccups can be extremely vexing for patients while they receive radiotherapy. I gauge my need for medical intervention based on their history of hiccup frequency and pattern through the day (e.g., night-time hiccups only), as well as the kind of other interventions the patient may have attempted. I ...
Is TTF treatment an appropriate option for recurrent GBM?
Absolutely. This was the first FDA-approved indication for Optune. Although it was approved in 2011, one could say that it never really "caught on." I personally did not start using it or recommending it until the second FDA approved indication (for upfront first-line treatment) appeared around 2015...
For retroperitoneal sarcomas, do you consider neoadjuvantly boosting the "posterior rind" or area at high risk of positive margin?
I routinely recommend preoperative IMRT to treat retroperitoneal sarcoma, although we have no level 1 evidence to support this approach. Currently the EORTC is conducting a phase III trial to investigate a role preoperative radiation (3DCRT or IMRT) in treatment of retroperitoneal sarcoma (primary e...
What dose/fractionation do you use when treating SCC of the vagina with vaginal cylinder brachytherapy after EBRT?
Typically, we give 5Gy x 3Fx prescribed to a depth of 5mm. However, this may be more than necessary. See this discussion: https://www.themednet.org/question/270
Do you use brachytherapy for treating primary tumors of the lip with definitive radiation?
I think the question for most of us is, would you use brachytherapy for treating primary tumors of the lip with definitive radiation therapy? The answer should be yes. I have done brachytherapy in many areas of the body and this is one of the easiest. These tumors tend to be small so this usually re...
How does the risk of urinary obstruction differ between HDR and LDR brachytherapy for prostate cancer?
I think it is important to clarify and distinguish between urinary retention and urinary obstructive symptoms for this clinical scenario. In general, the likelihood of urinary retention requiring catheter placement after the brachytherapy procedure is less than 5% with either high-dose rate brachyth...
Should we continue to offer consolidative radiation for early stage, non-bulky Hodgkin's disease for individuals who have had a complete response (Deauville 1 or 2) after chemotherapy by PET?
The RAPID study was a non-inferiority trial. This requires a small editorial. Non-inferiority trials are designed to test that one approach is "not worse" than an accepted standard. However, in essence you are testing that one approach is "not unacceptably worse" than an accepted standard, because t...
For patients with widespread bony metastases from prostate cancer, do you ever consider treating with beta-emitters such as Samarium-153 or Strontium-89 over Radium-223?
I use radium 223 in all patients unless thier performance staus is poor ECOG-2 or they have significant visceral disease. In those cases it may difficult to get authorization for Radium 223. In terms Cost effectiveness there is data now from the ALSYMPCA trial updates that patient's who received Rad...
Are your criteria for PMRT in men different than your criteria for PMRT in women?
Our indications and need is based on data from treating women with breast cancer and thus follow similar indications. Although because of lack of breast tissues and screening men are more likley to present with advance disease especially extending to dermis and thus moe likely need PMRT