Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach cT3N0M0 squamous cell carcinoma of the supraglottic larynx in a patient with a history of breast cancer and prior radiation to the supraclavicular fossa?
I would try and get the prior radiation treatment plan to ensure that the supraclavicular fossa was adequately treated and to determine exactly how high up the fields went and attempt to match elective nodal coverage to about that level. In the absence of the prior radiation information, I would lik...
What whole brain radiation dose would you recommend for primary CNS lymphoma with partial response to HD-MTX-R and R-ICE and planned for concurrent ibrutinib?
There are many uncertainties in how to optimal treat patients with PCNSL. It is clear that high-dose MTX-based regimens should be pursued when feasible. The role, if any, of RT is controversial. If pursued, a WBRT-based approach is generally considered most appropriate.With that said, if a patient o...
How do you approach post-operative SRS for melanoma metastases in the setting of immunotherapy?
I always offer postop SRS or HSRT as after surgery, the blood supply of the area will be compromised affecting drug delivery.
How do you approach volumes and dosing when using SBRT for a biopsy-proven NSCLC lung nodule with a central solid component and surrounding ground glass opacity (GGO) appearance?
@Dr. First Last, first of all, congratulations on finding our rather obscure article. It's heartening to know that it's impact has reached such high levels that a specific literature search on the topic by my esteemed colleague @Dr. First Last fails to find the article. I shall have to resort to soc...
Would you offer SRS to a hippocampal metastasis in a patient with ES-SCLC treated with prior WBRT?
I agree with Dr. @Dr. First Last. The brain metastasis is a greater risk to the patient than SRS would be. Whether the prior WBRT used hippocampal sparing or not would not change my recommendation.I am not well-versed in neurocognitive anatomy. But it is feasible to injure (or remove) 1 hippocampus ...
When do you offer adjuvant chemotherapy after wide-local excision for soft tissue extremity sarcomas?
High risk extremity and superficial trunk STS, AJCC stage 3. Data is more convincing in Sarculator, which projected a risk of recurrence higher than 40%. If resection has already happened, adjuvant XRT has to follow first before adjuvant chemotherapy.
How do you optimally set a patient up for breast radiation therapy if you don't have access to a breast board or wing board?
"Optimally" is a continuum and hard to define. Without a breast board or wing board, a vac-lok bag might be your best bet. You can often move much of the "beans in the bag" superiorly in the bag, so that you can create something to support the patient's ipsilateral arm(s). Plus, moving the beans sup...
How will you treat an uterine embryonal rhabdomyosarcoma with regional node involvement resected to involved parametrial margins?
It's hard for me to say how I would treat the patient as described without a bit more information and review of the case. So, I will make a few general comments. One major question is, "What is the age of the patient?". And I assume from the question that the parametrial margins were involved. Two t...
What is the risk of radiation therapy to an abdominal aortic aneurysm infiltrated by lymphoma?
I have no personal experience treating an AAA infiltrated with lymphoma. I believe, however, it is appropriate to draw an analogy with treating stomach or bowel involvement with lymphoma. In this situation, chemotherapy may well result in perforation due to rapid tumor shrinkage, whereas fractionate...
How would you manage a patient diagnosed with squamous carcinoma involving the entire length of the vagina and extends into the vulva (introitus), who has severe vaginal stenosis?
If this is a vaginal lesion involving the vulva, it should be classified as vulva cancer and treated like so. Typically with ext beam boost to 66 to 70 Gy.