Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is is okay to offer SBRT for central lung tumors in direct contact with the esophagus?
My short answer is: probably not, if you are considering standard regimens like 10Gy x 5. The risk of fistula appears to be significant if you expose the esophagus to full prescription dose. My group described two patients receiving lung SBRT who developed significant esophageal complications (fistu...
For esophageal cancers with large gaps between the primary and PET positive lymph nodes, do you treat the gaps with continuous volumes or only involved areas?
As is true for much in medicine, there is no simple answer to this question. For a patient with a cervical esophageal cancer, perigastric lymph nodes are essentially metastatic. There is no clear dividing line as to when a node is metastatic vs regional disease. We know that for tumors of the lower ...
Would you recommend post mastectomy radiation for a low grade adenoid cystic carcinoma of the breast resected with negative margins?
Generally not. I would consider it if the tumor were exceptionally large relative to breast size and probably would offer XRT if it were ulcerating the skin; otherwise, surgery with negative margins provides adequate local control, and the incidence of nodal involvement with ACC is very low. XRT wou...
Would you recommend adjuvant radiation therapy to a T4N0 colon cancer with invasion into other organs or the abdominal wall status post R1 resection?
Given the relative dearth of data for radiotherapy in the management of T4 colon cancer, one of my residents, Dr. Chris McLaughlin just completed and published a SEER database analysis on this population of patients (McLaughlin et al. Radiother Oncol 2019). He found that only about 5% of patients wi...
Does the presence of thrombus in the sinus affect your decision between fractionated radiation and SRS for recurrent grade 1 meningioma?
The presence of a thrombus in the venous sinuses can be a significant risk factor for post-treatment complications after SRS for meningiomas originating near or attached to the sinuses. Venous sinus thrombosis can be increased by the SRS, leading to venous infarction, which can cause a range of neur...
In patients with vertebral bone metastases, what criteria do you use to select patients for kyphoplasty referral prior to palliative radiotherapy?
In patients with painful malignant verterbral fracture without overt instability or neurogenic compression that would warrant surgical consultation, kyphoplasty can be considered either before or after palliative radiotherapy. Vertebral augmentation to achieve immediate pain relief prior to radiothe...
Would you consider RNI alone without CW for an isolated nodal recurrence after treatment with mastectomy and SNB for an early-stage breast cancer with no prior RT?
I favor comprehensive RT unless there are contraindications or the patient declines because of the impact on cosmetic outcome.
Does radiation therapy (ex. to the breast) in patients with CDK4 mutations increase the risk of developing melanoma?
I am unaware of any literature supporting the fact that RT in patients with CDK4 mutations increases the risk of melanoma development. There have been studies, with conflicting results though, looking at whether there is any increased risk or incidence of melanoma in patients with breast cancer wh...
What vertebral body dose constraint do you use in SBRT to limit compression fracture?
Vertebral body compression fracture after stereotactic radiation is a complicated topic with multiple contributing factors. Different institutional analyses have demonstrated lytic tumors, bony involvement by tumor >40%, age >55, pre-treatment pre-existing fracture, histology, spine deformity, and d...
What is your strategy to prevent and treat constipation in patients initiating or receiving opioids?
I am a radiation oncologist and palliative care physician.I teach: "the hand that writes the opioids, writes the laxatives - or else it does the disimpaction". Opioid induced constipation is very common, can cause physical and psychological discomfort, and have a major impact on quality of life. It ...