Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer re-irradiation for a prostate local recurrence after I-125 seed implant >10 years ago in a healthy young patient with life expectancy >15 years?
While I think salvage re-irradiation does have the potential to become a routine option in such situations, I think further study is required to define both the efficacy and toxicity profile prior to establishing it as such. The current state of knowledge is based on limited information, as Dr. @Dr....
Does lymphovascular invasion trump POLE mutation in early-stage uterine cancer adjuvant therapy decisions?
In the current ESGO guidelines, stage I and II POLE types are always low risk, irrespective of substantial LVSI, with a predicted risk of recurrence being less than 10 percent, and favoring observation. That being said, in practice, I do offer brachytherapy, as I feel it is a low morbidity procedure...
Would you offer cisplatin concurrent with radiation to a patient with p53-mutated stage III endometrial cancer if she has adult-onset hearing loss and uses a cochlear implant?
Cisplatin is commonly used for radiosensitization in patients being treated for gynecologic cancer. Ototoxicity is a common side effect of cisplatin. It is caused by the death of outer hair cells in the inner ear. Cochlear implants are used to treat hearing loss in patients with severe hearing loss ...
How do you modify the management of an SLE patient with active systemic lupus for a gynecological cancer that normally requires pelvic radiation and brachytherapy?
I have not done any specific modification for SLE. I would treat with VMAT and IGRT with a 5 mm PTV margin and ensure EBRT and HDR meet ideal dose constraints for OARs.
How would you treat a small cell carcinoma with a 4 cm right Bartholin's gland primary and a single small right inguinal adenopathy?
It’s like limited-stage SCLC would be treated with cis plus etoposide and RT (60-66 Gy). Will favor no elective pelvic node RT if pure small cell carcinoma and no mixed component.
How long after surgery would you no longer offer PMRT for a patient who had pCR after neoadjuvant chemotherapy for stage IIB HER2+ breast cancer?
The value of PMRT in HER-2 positive stage II breast cancer with pCR is debatable, to begin with, and now with 6 months or more delay, I would favor no RT.
What treatments, after appropriate dose reductions/delays, do you offer for patients with oxaliplatin-induced cold allodynia/dysesthesia?
The primary treatments that I use for cold-induced oxaliplatin neurotoxicity are reducing the oxaliplatin dose and limiting the duration of oxaliplatin treatment (usually not more than 16 weeks of oxaliplatin-containing therapy in the initial line of treatment). Medications that are effective for pa...
How would you treat a high intermediate risk stage IA grade 2 endometrial ca?
If it is Stage IA, Grade 2 without additional risk factors, we recommend observation. It is not considered high intermediate risk.If it is Stage IA, Grade 2 with additional risk factors such as LVI or age 60+, we recommend a referral to radiation oncology to discuss. Anecdotally, most patients will ...
What normal tissue constraints do you use, if any, in patients receiving vaginal cuff brachytherapy alone?
We optimize based on the PORTEC 2 and PORTEC 4 protocol recommendations. We use CT-simulation and 5mm optimization points. There are no normal tissue constraints when using this approach and 2D planning can be utilized. We do not insert, for example, bladder points. Many planning studies have demons...
Would you consider chemoradiation + chemotherapy as in PORTEC-3 regimen for p53 mutated stage IA endometrial cancer, though this trial did not include those with stage IA disease?
There are not sufficient data to recommend this regimen in patients with stage IA endometrioid endometrial cancer. In subset analysis of patients with grade 3 endometrioid cancer with + LVSI, there was no difference in recurrence free or overall survival (OS) with the addition of chemotherapy. For p...