Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there increased risk with lung SBRT in a patient who has a mild asymptomatic pneumothorax in the field after CT-guided needle biopsy?
I'd be curious what others thought but my quick thought is probably not. If I can extrapolate (i.e., make up) what might be the course of events and what you might want to consider... You send a patient for bx to confirm malignancy and see them right after for sim. The patient is noted by IR to have...
How would you manage a patient with a small Type A Thymoma, who is not a candidate for resection due to medical co-morbidities?
Surgical resection still remains the gold standard for thymic tumors, with the ultimate goal of achieving an en bloc removal of the thymus and perithymic fat without tumor capsule violation. Nevertheless, there is mounting evidence that minimally invasive surgical thymectomy approaches (robotic-assi...
Do you modify your target volume for treatment of trigeminal neuralgia confined to a single branch of CN V?
Short answer: NO. Target is preferable to the cisternal segment and we have always cusped into the DREZ on the first treatment. Distal treatment nearer the Meckel's Cave and even beyond becomes more akin to a Rhizotomy and will have more likelihood of sensory loss and ultimately deafferentation pain...
For patients that fail initial SRS for trigeminal neuralgia, what factors do you consider when considering re-irradiation?
Failure within 6 months/No response: Is vascular compression present? Yes = Consider Microvascular decompression. If contraindicated repeat SRS to 50 Gy. No + then was the nerve clearly visualized on MRI? Yes = Possible repeat SRS to 50 Gy. No = then that could be a cause for failure, consider ret...
Do you treat bilateral trigeminal neuralgia with SRS?
Yes, but I treat the side with more severe symptoms first and treat the other side 6 months later. I do not make dose modifications. I have treated some patients with bilateral trigeminal neuralgia in this fashion with no issues.
For incidentally found stage I indolent non-Hodgkin's lymphoma in young patients, which subtypes would more strongly warrant a consideration for curative-intent radiation?
In general, national guidelines recommend definitive RT for early-stage, low-grade NHLs. These are a diverse collection of diseases with different natural histories and outcomes after treatment. In brief... 1. Follicular lymphoma - typically a disease of older adults with ~20% presenting with early-...
For plasmablastic lymphoma responsive to treatment except for a recurrent lymph node eroding into a vertebral body at the end of chemotherapy, would you cover the entire vertebral body in your CTV, or treat only the involved lymph node with a margin?
Plasmablastic lymphoma is an aggressive NHL that typically occurs in the H&N region, typically in immunosuppressed individuals. Most patients present with advanced disease. The role of RT is not firmly established. That said, in a patient only achieving a PR to systemic therapy with localized residu...
Would you offer a male patient adjuvant radiation for treatment of his breast cancer if his axillary dissection specimen shows a single node with isolated tumor cell(s) (ITC)?
If a male patient had a mastectomy with ITCs in a single node, I would not recommend adjuvant radiation.
Do you treat supraclavicular metastasis with SBRT?
I'd view this as nodal oligomet occurring in the supraclavicular area. I've treated patients with SC nodal met and I always try to push the dose to 40 Gy in 5 fxs if the brachial plexus (BP) tolerance can be respected. I typically use 30 Gy in 5 fxs as constraint for BP. This is for RT naive patient...
For NSCLCa patients who are found to have N2 disease at time of surgery, what treatment volume do you use for PORT?
A post operative "surprise N2" should not be a common occurrence. These patients warrant systemic chemotherapy first. They are, of course at risk for local and systemic failure, and it was not until Drouiilard's observation from the ANITA trial that we were invited back. Subsequently, it is agreed ...