Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is chemoradiation the preferred treatment for T2 SCC of the anal canal in a patient with IBD?
Yes, but I typically reduce the dose. In this case, 50.4 Gy in 28 fractions with 2 agent chemotherapy is a very good treatment. The worst case scenario is that the patient would need an APR. That could be because you declined to treat her or him, or because the tumor was not controlled with 50.4Gy. ...
Is adenocarcinoma of the vulva more radioresistant than squamous cell carcinoma?
In general, SCC responds better to radiotherapy than adenocarcinoma, therefore I agree with @Dr. First Last that I would advocate for surgery (if possible) for these entities - however, given their location (close to introitus), often they will warrant adjuvant radiotherapy.
In patients with high risk prostate cancer and involved common iliac lymph nodes would you recommend radiation?
This study from Tata, Mumbai shows outcome data treating pelvis only up to the common iliac nodal region and shows similar outcomes for pelvic node, proximal and distal common iliac positive disease Chopade et al., PMID 35870708
Under what circumstances would you offer PMRT in a patient with DCIS?
I favor in the setting of multiple positive margins, especially for high-grade DCIS.
How would you approach a mediastinal-only presentation of squamous cell carcinoma of the lung s/p lymph node biopsy consistent with lung origin, with PET positive for only mediastinal disease?
First, I would confirm no prior cancer diagnosis, review in detail with a multidisciplinary tumor board, and try to rule out the non-lung primary site. If no primary can be found, and PET demonstrates limited disease only in the mediastinum/hilum, then I would just treat the disease that you can see...
Is morphea, cutaneous scleroderma, with no organ involvement a contraindication for radiation in early stage breast cancer as part of breast conservation therapy?
I am not sure anyone can answer this question with a solid yes or no answer. The information we have about limited scleroderma and radiotherapy is for, lack of a better term, limited. We can draw from some experiences to guide the thought process. In one large series of patients from two scleroderm...
For inoperable cholangiocarcinoma, do you recommend up-front chemotherapy prior to offering SBRT or combination chemoradiation?
For inoperable cholangiocarcinoma, there are many factors to consider. First, does the patient have any metastatic disease? If no, then how large is the primary and are there any nodes? Finally, is the patient suffering from biliary obstruction - causing hyperbilirubinemia and persistent/recurrent c...
Do you utilize consolidative RT for oligometastatic HPV positive head/neck cancer with stable disease on immunotherapy?
This is a difficult question to answer since there is little if any data for guidance, and also the management of this issue is evolving with regards to the increasing impetus to treat oligometastatic disease aggressively, and the increasing use of immunotherapy in patients.This specific question al...
In the setting of unresectable Ewing's sarcoma in an adult, would you consider boosting to a higher dose?
I would not hesitate to dose escalate to 60-64Gy if indicated by other adverse risk factors. I think size, response, and medical condition of the patient are all important in determining if it is appropriate to dose escalate in Ewings. Local control for definitive radiation of vertebral body tumors ...
How would you approach SBRT in a pacemaker-dependent elderly patient with Stage I NSCLC whose SBRT plan Dmax exceeds the pacemaker tolerance?
For any patient who has a pacemaker, we always send them to be evaluated for the device by a cardiologist before simulation and after finishing all fractions of the SBRT. In addition, we check their vital signs daily after each fraction of SBRT. For SBRT planning, we will minimize irradiating the p...