Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose/fractionation would you offer a non-operable patient with a low-lying T2N0 rectal cancer in the setting of prior pelvic radiation >10 years ago?
Assuming non operable excludes local excision, I would treat with contact therapy.
How would you best manage C-spine osteoradionecrosis?
HBO, pentoxyfylline, vitamin E, and prayers. I can’t imagine surgery would be useful except as a last resort. I’m extrapolating from the mandible and maxilla. I don’t recall seeing an ORN of a cervical vertebra. Thankfully.
What is the soonest you can start adjuvant whole breast radiation after surgery?
My general preference is 4-6 weeks (up to 8 weeks) expecting normal healing. I rarely start sooner than 4 due to healing concerns (even if things look good) and have only done this (starting 3-4 weeks post op) a few times due to extenuating circumstances, and only if the healing appears adequate. I ...
How would you treat a head and neck patient who had definitive chemoradiation who develops an isolated mediastinal lymph node recurrence?
45 Gy/25 fx to mediastinum and boost to positive node to 65 to 70 Gy.
Do you recommend salvage XRT to the prostate bed in the setting of oligometastatic prostate cancer after RP?
In the setting of oligometastatic disease, we currently have reasonable evidence to treat gross disease. Following that logic, I treat the fossa if there is gross disease on imaging (preferably with biopsy confirmation). In the absence of compelling evidence for a local recurrence, I only treat the ...
In patients with history of prior axillary surgery, subsequently with breast cancer recurrence, and sentinel lymph nodes mapped to internal mammary area (but were not biopsied), do you offer post-mastectomy radiation to cover the IMNs?
I would favor including as there is possibility of microscopic disease based on T stage and phenotype.
How stringent or flexible are you with concurrent chemotherapy and radiation starting on the same day in the definitive CRT setting for HN patients?
I am OK with RT starting a day or two after chemo, usually we may need some extra time planning and doing the vsim, shouldn't really be a big deal with RT starting a little after since the chemo is a sensitizer and it will already be in the patients system when we start RT
Would re-excision of close margins (1 mm) allow a patient to avoid post-op radiation for a patient with metachronous diagnosis of a FIGO Stage IB vulvar cancer who also had a prior contralateral vulvar cancer resected 15 years ago?
Yes, would avoid RT if re-excision is done to get a wider margin.
How would you treat a high risk Merkel cell carcinoma of the lower leg after R1 re-resection who failed sentinel mapping?
This situation is very unusual. I can't recall ever seeing a patient have a failed sentinel lymph node biopsy procedure AND a positive margin after attempted re-excision of a Merkel cell carcinoma of the leg before. This leads me to wonder whether the patient should consult another surgical oncologi...
For Merkel cell carcinoma of the lower extremity with early isolated recurrence in the ipsilateral inguinal nodes, would you include pelvic lymph nodes in the post-operative field following inguinal lymph node dissection?
We have traditionally offered post op RT for all node positive MCC.We typically include the lower pelvic nodes (Ext Iliacs) and exclude bowel after 46 Gy by field reduction.