Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does the presence of a POLE mutation in endometrial cancer guide your recommendations regarding adjuvant radiation?
It’s part of PORTEC 4 study to randomize patients to adjuvant RT based on molecular subtype. They are exploring if observation is suitable option for POLE type Outside of a trial we still decide based on stage and grade for adjuvant treatment and not on molecular subtype.
Is 500 cGy x 5 an appropriate palliative regimen for a patient with a low-lying metastatic rectal cancer with ongoing pain and bleeding despite chemotherapy?
25 Gy in 5 fractions is my preferred regimen for palliation of a symptomatic rectal primary in patients with metastatic rectal cancer. I’ve used it numerous times with generally very favorable results for symptom palliation, local control, and tolerance. There is also a couple of series which have u...
Would you treat with extended field pelvic radiation for a patient with FIGO IIIC1 endometrial cancer who was found with isolated tumor cells (ITCs) on a single paraaortic sentinel lymph node?
I would favor pelvic and PA nodal RT as it has an increased risk of additional disease in the PA region with a combination of pelvic node-positive and ITC in PA node.
Is there a role for adjuvant nodal irradiation for early stage squamous cell carcinoma of the penis?
Data to answer this question are limited to retrospective analyses given the relative rarity of penile cancer. A PET scan can also be useful in absence of surgical evaluation of the regional nodes. Sanchez-Ortiz and Pettaway (2004) have compiled the results of several case series in attempt to help ...
Are there any circumstances where you recommend early institution of systemic therapy for patients with solitary plasmacytoma?
Assuming a true solitary plasmacytoma with no bone marrow involvement, I do not recommend systemic therapy in almost all circumstances. However, there are times when the location of a solitary plasmacytoma precludes definitive/curative dose radiation; even with surgical resection, I would favor syst...
Would you consider chemo-RT for duodenal adenocarcinoma s/p resection with at least 1 cm positive margin in a patient with a history of Crohn's disease?
I would not offer radiation in this scenario, especially if the patient has had multiple resections for Crohn's disease. There is no real data to guide adjuvant radiotherapy in duodenal cancer, but we borrow and extrapolate from other sites and rely on first principles to offer adjuvant treatment. H...
For a patient who has undergone preoperative chemoradiation to 50Gy for locally advanced rectal cancer followed by LAR or APR, would you treat a positive margin with radiation therapy?
No. The majority are still controlled locally even with a positive margin. The cells seen on histologic evaluation may be clonogenicly dead. After an 8-12 week interval, there is not much that can be done with more irridation anyway. Previuosly irradiated fixed bowel could be in the field. Furthermo...
How would you manage recurrent anal SCC after chemoradiation, with positive margins after resection?
There aren't many details given about the recurrence. If it is a local recurrence, I would suggest repeat attempt at surgery be considered. If it is a distal recurrence, one could consider carboplatin and paclitaxel chemotherapy (based off of this InterAAct trial). Increasingly, I am favoring checkp...
When using surface image-guidance for breast radiation, how do you accommodate for changes in anatomy?
It depends on the timing (where they are in their treatment course). If there is a notable change, we will re-CT, especially for seroma shrinkage. Sometimes, if there is a discrepancy within the first couple of treatments, we will re-capture the surface-guided setup. There are some data present indi...
What alternatives do you recommend for oral dexamethasone solution for HN cancer?
For oral mucositis, I would try MuGard. Be aware it is expensive, so often requires auth for approval. You can also try Carafate suspension qid.