Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When would you consider omitting breast radiation in a <65 yo woman who is s/p BCS?
Off trial, I do not consistently recommend omission of radiation for patients younger than 65. There are studies underway looking at omission in lower risk (ex. luminal A) in patients younger than 65 and studies looking at older randomized trials suggest such a low risk cohort may exist.I do conside...
Should all pediatric CNS cases be referred to a proton center?
I hope there will be a substantial amount of debate on this question, and so I have invited several pediatric radiation oncologists treating patients at institutions where protons are and are not utilized. The weight of the building data on this topic in the literature is mounting such that more and...
Is there any advantage to proton beam therapy in a locally recurrent anal carcinoma, which has already been treated with concurrent chemo RT as well as APR for relapse?
Even with a local recurrence, patients’ life expectancy can be relatively long, which often introduces the question of repeating radiation treatment. Although this option must be balanced with the potential toxicities and consequences of re-treatment, the possible morbidity from tumor progression is...
Do you recommend adjuvant RT to patients with non-ATM genetic mutations (e.g. BRCA, NF) who elect to have lumpectomy and are otherwise PRIME II/CALGB candidates for RT omission (i.e. low risk disease characteristics: strongly ER+, <1cm, grade 1-2, no LVI, widely negative margins, and committed to endocrine therapy)?
Again, as in the previous hypothetical, this patient is otherwise well-qualified and has chosen to forego surgical prophylaxis. Is she eligible for PBI? If not, she should have whole-breast?… And perhaps contralateral “radiation prophylaxis”? I don’t believe so. In the studies you referenced, we did...
What dose/fractionation would you recommend for primary aneurysmal bone cyst of spine after a subtotal resection?
See the articles below: Mendenhall et al., PMID 16755186 Zhu et al., PMID 26165419
How do you manage incidentally identified pituitary lesions on brain imaging?
Pituitary lesions are among the most common incidentalomas seen on brain MRIs. Various studies cite numbers as high as 10- >30% for pituitary lesions found incidentally on brain imaging, with the higher incidence rates emerging in the era of high-resolution MRIs. In pediatric neurology/neuro-oncolog...
Do you ever consider a third course of CNS radiation to the same area for an in-field recurrence?
I’m assuming this is for brain metastases? If so, would be helpful to know how long and interval time of the first and second RT treatments. Would discuss this at our brain mets tumor board. Any particular reason why not surgical or LITT candidate? If this patient has a good KPS, no or minimal extra...
What dose do you use for definitive treatment of squamous cell carcinoma of the cervical esophagus?
Our institutional preference is to employ a total dose to 70 Gy with concurrent chemotherapy for squamous cell carcinoma of the cervical esophagus, because a local failure in would require salvage surgery with pharyngo-laryngo-esophagectomy. The role of dose escalation in squamous cell carcinomas of...
Would you offer partial breast radiation for bilateral DCIS?
Yes, would offer APBI
Would you recommend PMRT to a clinically node positive (biopsy proven axillary node and indeterminate single IMN node) BRCA positive patient with multiple medical co-morbidities including scleroderma and ILD who is treated with neoadjuvant chemotherapy (NAC) and mastectomy who converts to ypT0/ypN0?
Given pathological complete response and comorbidities, I would favor the omission of RT. While not a clear B-51 case, if you think IM was involved, given the totality of the situation omission is how I would go as long as post-chemo MRI showed stable or smaller IM node.