N. Serrano

Reducing rectal injury in men receiving prostate cancer radiation therapy: current perspectives

Dose escalation is now the standard of care for the treatment of prostate cancer with radiation therapy. However, the rectum tends to be the dose-limiting structure when treating prostate cancer, given its close proximity. Early and late toxicities can occur when the rectum receives large doses of radiation therapy. New technologies allow for prevention of these toxicities. In this review, we examine the evidence that supports various dose constraints employed to prevent these rectal injuries from occurring. We also examine the use of intensity-modulated radiation therapy and how this compares to older radiation therapy techniques that allow for further sparing of the rectum during a radiation therapy course. We then review the literature on endorectal balloons and the effects of their daily use throughout a radiation therapy course. Tissue spacers are now being investigated in greater detail; these devices are injected into the rectoprostatic fascia to physically increase the distance between the prostate and the anterior rectal wall. Last, we review the use of systemic drugs, specifically statin medications and antihypertensives, as well as their impact on rectal toxicity.

Patient autonomy and shared decision making in the management of urethral cancer

Department of Radiation Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia Department of Radiation Oncology, Indiana University, IU Health Arnett Cancer Center, Lafayette, Indiana Hematology Oncology Section, Medical Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia Division ofHematology,Oncology andPalliative Care, VirginiaCommonwealthUniversity,MasseyCancerCenter, Richmond, Virginia Department of Urology, Virginia Commonwealth University, Richmond, Virginia Department of Urology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia Department of Radiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia

Overview of Radiation Oncology Evaluation and Management of Breast Tumors

Radiation therapy is indicated as part of the standard of care treatment for the majority of patients with breast cancer. Large clinical trials evaluating the efficacy of radiation treatment for breast cancer date back more than a half century. This chapter discusses the indications for adjuvant radiation therapy for ductal carcinoma in situ and invasive breast cancer. It explores the data supporting the indications for radiation therapy and the benefit of radiation therapy in various clinical settings. Also discussed are the role of regional nodal irradiation, the indications for shorter radiation treatment schedules, and the benefit of a radiation boost. This chapter further addresses the role of partial breast irradiation, and lastly, it discusses the clinical scenarios where omission of radiation may be considered. The role of radiation in treating breast angiosarcomas and malignant phyllodes tumors is not addressed here because these topics are more appropriately discussed in the context of the management of sarcomas.