Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for selective arterial embolization of RCC before primary SBRT?
An interesting question! A good way to approach this question is with a list of potential advantages and a list of potential disadvantages. For the record, this is all hypothetical. I am not aware of any published literature that has explored this concept.Advantages: Significantly reduce the size of...
In a patient with anorectal SCC, T2N0, with a history of bladder prolapse managed with pessary, would the pessary need to be removed prior to radiation?
I don't see a problem having a pessary in place at the time of each treatment, if the patient needs it in place in order to function. To reduce the risk of long-term vaginal stenosis, these patients should also have a vaginal spacer inserted at the time of each radiation treatment to better spare th...
How would you approach radiation for node-positive prostate cancer in a patient with an aortic and/or common iliac arterial aneurysm not meeting criteria for surgical repair?
Literature has shown a correlation of brain irradiation associated with the development of intracranial aneurysms - I believe that is the concern this question is raising.The good news is that other studies have shown that, at least for the aorta, existing large artery aneurysms are not worsened by ...
In a patient with inflammatory triple-positive breast cancer who has a pCR to neoadjuvant chemotherapy, but has an incidentally found focus of intermediate-grade ER+/PR+/HER2- ILC in the mastectomy specimen, how would this impact your adjuvant radiation recommendations?
This finding would not have any impact on my recommendations, since her management needs to be guided by the inflammatory breast cancer. That means chest wall plus nodal irradiation tailored to the findings of axillary surgery. There are no data on whether we can decrease the dose in patients with a...
What is your radiation approach to metastatic pancreatic tail adenocarcinoma s/p gem/abraxane and FOLFIRI now with an oligo-progressive LUL lung metastasis?
I certainly would favor metastasis-directed therapy with SBRT, given the PFS benefit observed in EXTEND, and I think the case for utilization in the oligoprogressive state is even stronger pan-tumor compared to consolidative treatment. I'd treat 50-55 Gy/5 fractions or could consider fractionating o...
How do you decide between stereotactic arrhythmia radiation (STAR) and repeat catheter ablation in patients with refractory ventricular tachycardia who have already failed one prior ablation?
This is a great question and something that the ongoing RADIATE-VT trial is working to answer (NCT05765175). In this phase III RCT trial, recurrent VT patients who have had at least one prior catheter ablation, are considered to be candidates for a repeat catheter ablation by their electrophysiologi...
Is it necessary to treat one vertebral body above and below for palliation of spinal metastases?
No. The reasons to go one above & below were to avoid the dreaded miss from the dreaded days of bone scans, plain films & port films. That is much, much less likely these days with IGRT, CBCT, MRI (PET, etc.). We know treatment volume size correlates with toxicity. You can get some dysphagia/esophag...
What is your radiotherapy plan for recurrent midline epidermoid cyst after resection around 10 months ago?
Radiotherapy for suprasellar epidermoid cysts is typically reserved for rare, recurrent, or malignant cases where surgical resection is not feasible. While microsurgical removal is the standard, adjuvant radiotherapy (conventional or stereotactic/Gamma Knife) can effectively manage residual or recur...
What hypofractionated regimens would you consider for postoperative SCC of the hand with a positive margin?
I have started to use 50 Gy in 20 fractions in all patients with a recent retrospective analysis from Australia for cutaneous squamous and basal cell cancers that has been used for head and neck patients, another sun-exposed site with cosmetic concerns. This type of question is hard to answer as man...
In a patient with high-risk cutaneous squamous cell carcinoma of the face with extracapsular extension after ipsilateral neck dissection and rapid contralateral cervical nodal recurrence, what is the optimal management?
In various published series, around half of patients fail to achieve a complete response to cemiplimab. From the clinical details, the current active area of disease appears to be the contralateral neck with no distant disease. Curative treatment is preferred. C-POST trial established surgery + adju...