General Radiation Oncology   

Any published reports or anecdotal experience to guide us? Post-operative endometrial with high-risk features for nodal recurrence, planning VMAT wit...

Any best evidence for a given schema?

Found small reports using SRS or fractionated SRS, but not feeling comfortable with this approach due to limited data. Would you consider surgery + co...

Do you use decipher, or other genetic testing to determine whether you will include pelvic lymph nodes when you give definitive EBRT? Can you comment ...

If a patient had a high dose of radiation to the spleen (10 Gy over 5 fractions) over a year ago but with increasing splenomegaly now, would you consi...

Or, to manage tenesmus and discomfort after any type of pelvic radiation.

What is your volume and point dose constraint within the vertebrae itself when prescribed 1 fx, 3 fx,  5 fx SBRT spine to reduce incidence of ver...

Does the volume of or recent progression of other non-spine disease influence your patient selection? Does the patient's performance status, eligibili...

If so, how long would you hold? This medication is given for migraines as q3 month infusions and some data suggest that CGRP plays a role in immune-mo...

Do you treat the whole gland or the lesion only?   What is the role of additional imaging (MRI, PET/CT) to delineate disease?  What e...

What is the risk of renal artery stenosis causing malignant hypertension and at what dose does this become an issue?

The patient is not pacemaker dependent. 

Do your recommendations differ between appendiceal, colorectal, and gastric cancer? If radiation is offered, would you boost the unresectable/gross re...

Is anyone advising delaying COVID booster until after PET/CT to avoid false positive?

Is there diminished radiotherapy efficacy in tumor control after certain timeframe has passed for malignant meningiomas with no signs of recurrent dis...

Is there any role for RAI?

If the radiation cystitis is hemorrhagic without clots how would you manage this?

What do you consider valid reasons to deliver 39 or more fractions for prostate cancers, 25 or more fractions for breast cancers or 10 or more fractio...

Is there any reason that this is not commonly done, apart from lack of RNI coverage?

Would you treat a knee?

If not, what interval between the patient's last RT and IT chemo would you prefer?

If imaging is aligned at PTV despite exceeding tolerances do you accept/override, perform shift verification image, or reposition the patient? Do you...

How will you approach patients with diffuse metastases who you would have otherwise deferred treatment? Prophylactic Radiation Therapy vs. Standard-o...

Would you offer radiation therapy? If so, what dose and fractionation would you use?

Is there any evidence to support the theory that this may cause worse skin reaction? 

Is there certain information or practices that you find sets the day up for success? 

What treatment margins/set-up/on-board imaging would you use?

If a treatment machine is down for 3 days, would you do weekend treatment? Would you consider doing BID?

What precautions can be taken to limit infestation of the department?   Do you implement a treatment delay and if so how do you decide when...

No additional systemic therapy is planned. Would you consider consolidative radiation therapy? If so, what dose?

Is there a specific brand or formulation you prefer? The literature supporting the use of probiotics does not standardize the type or dose of probiot...

If a patient had prior breast conserving treatment and now has inflammatory breast disease, would you prophylactical send the patient to a cardiologis...

If a patient is not a surgical candidate, what it the most appropriate treatment? 

If pathology review is done and all imaging scans including CT scan, PET scan and MRI have come back without a primary site, is it reasonable to close...

Are you doing more TNT to prolong time to surgery? If so, do are you starting with CRT or chemotherapy?

For example a power outage. While highly dependent on clinical scenario, is there some general guidance on whether to add another fraction or how else...

Given the CALGB 9343 trial, as well as the recent "Choosing Wisely" recommendation (https://www.choosingwisely.org/clinician-lists/sso-sentinel-node-b...

Apart from H&N SCC, are there times where adding an extra dose of radiation due to a tx break is appropriate?  Is there a decent equatio...

Does anyone have experience re-treating the axilla and what dose/fractionation would you recommend?

While likely dependent on the case, do you ever view CTV coverage alone as sufficient in certain areas to meet an OAR constraint such as parotids? Thi...

In a patient being treated with a palliative course of radiation for a bony metastasis from lung cancer is it safe to start immunotherapy for POD or w...

Does it depend on the DMARD type (biologic, targeted synthetic, or conventional synthetic)?

Would inhaled steroids help reduce the PO dose and/or significantly accelerate tapering?  If s, for what pneumonitis grade? What specific steroid...

For a patient receiving 16 mg/day, it is frequently prescribed as 4 mg q 6 hrs.  This results in the patient being awoken at night, when sleep di...

   

Have you found any of the more common medical treatments (chlorpromazine, baclofen) to be most effective in the setting of throacic radiation or head ...

I know many centers are exercising extra precautions in light of the new concerns with coronavirus. How are people explaining things to their patients...

In treating skin cancers of the scalp,  are there any specific constraints you give to the skin itself to prevent alopecia?  How does changi...

What is the appropriate timing and what factors do you consider when making such a recommendation?

For instance, should post-operative radiation therapy be offered a patient with a 4 cm malar SCCA, resected with negative margins, no PNI, and a compl...

Are there certain cases or body sites where you feel daily CBCT is adequate?

How long is too long to resume SBRT, and would you increase doses? Is there a number of elapsed days that would cause you to abort completion of SBRT?

Dose is change based off of the radiation toxicity, such as poor wound healing vs radiation proctitis? What is the minimum amount of time that you wou...

How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...

Are your practices adjusting priorities at this time? If so, what adjustments are you making? If not, do you have metrics in place that will tell you ...

Would you offer RT? If so, shat dose fractionation do you recommend? 

This question has come up most frequently with respect to the flu vaccine recently. Also, frequently this has been asked about the shingles vaccine an...

Would you transfuse platelets before holding RT? 

Would you treat this AP window node like small cell lung cancer with chemoRT?

Further surgery is not possible.

If you do rechallenge is there anything that can be done to prevent the recall reaction from happening again?

Would this location be adequate for SABR, if so what dose scheduling would be recommended?

Does it matter if it's within the treatment area (such as breast cellulitis in a breast patient or a UTI in a pelvic RT patient) or outside the treatm...

Do you look at max dose or are there specific volumetric constraints you use for the small or large bowel? 

There have been case series published on this topic (most recently, PMID:26853347) with reported depigmentation within the RT treatment field.

Would you consider treating 3-5mm lesions with SBRT or wait until they are a certain size? I am concerned I will not be able to see them adequately on...

Do you use a different set of dose constraints for situations requiring treating much of the pelvis, e.g. rectal cancer, versus partial pelvis, e.g. a...

For a Stage III NSCLC looking to do definitive chemoRT who required IVIG and high-dose prednisone for paraneoplastic myopathy (mimicking dermatomyosit...

How long do you advise them to refrain from unprotected sex following RT? I was trained to discuss these issues with patients but the gonada...

It seems that we have increasingly been seeing younger patients with breast and rectal cancers.  What rates of radiation-caused secondary maligna...

Do you refer all patients who are felt to be at high risk to a genetic counselor for testing or are you comfortable performing a MyRisk panel in your ...

Should the patient be counseled to anticipate a worse skin reaction than normal?

Is there evidence of decreased toxicity in the lung, brain, pelvis, breast or abdomen with 1.8 Gy fractions to justify longer treatment schedules or w...

There is some data that suggests PSA and EBV can flare early in radiation therapy treatment courses in prostate and nasopharyngeal patients, respectiv...

For example, would you counsel against breast conserving therapy for a woman exposed to fallout from the Chernobyl disaster or a downwinder?

We often counsel patients that they shouldn't take very high doses of antioxidants but taking a daily multivitamin with antioxidants is OK. Do you thi...

If a holiday falls during the week do you treat all patients, a select subset of patients (i.e. cervix, head and neck) or give everyone the ...

Do you routinely ask all women of childbearing potential to have a pregnancy test? If so, do you get a pregnancy test before their CT simulation or th...

Published data show a mixed review of late toxicity with adjuvant radiation. What are guiding principles we should use as more patients are getting ge...

For instance, would you treat an anal cancer in someone that has a healing perianal access? What do you look for when considering initiating treatment...

Does it make a difference if you place the bolus above or below the mask? 

Does the recommended frequency depend on the dose that the device is receiving?

For a patient who has completed 40 hyperbaric sessions with steroids with little improvement, what other options exist?

E.g. breast? I have found no literature on skin tolerance acutely or chronically.

Do people use it interchangeably with DMax or use the 2cmx2cm definition? I often get pushback from the dosimetrists for plans where the DMax is ...

We can always find individual cases from time to time in which the care deviated from the “standard of care” and these can be referred for...