Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your target volume when treating lymphoid hyperplasia of the lacrimal gland with radiation therapy?
Agree with treating the lacrimal gland only. For a symptomatic, polyclonal reactive lymphoid infiltrate unresponsive to less aggressive treatments, I think low-dose RT is reasonable. I would give 2 Gy X 2.
For what patients are you adopting the PROSPECT approach into your rectal cancer practice?
Yes, the results of the trial are certainly factored into a multidisciplinary discussion. It is important to have a multidisciplinary discussion and to have shared decision-making with the patients. We often incorporate response to FOLFOX in this setting to decide. Although it is very subjective, we...
What dose do you use for postoperative rectum boost?
To the best of my knowledge there is no good information on this topic. I rarely use post RT nowadays. However, when I do, I have not gone higher than 54 Gy when it is truly an adjuvant treatment, and I often stopped at 50.4 Gy. The main limiting factor is toxicity, both small bowel and residual rec...
How do you manage early stage anal or anal margin cancer that is locally excised with negative but close margins when going back for wider margins would require an APR?
I've seen this scenario several times when a patient has an excisional biopsy (the surgeon doesn't think it is cancer) and leaves behind a positive or close margin. After properly staging the patient with pelvic MRI, I typically recommend adjuvant chemoradiation since they are at risk for recurrence...
What is your treatment approach in a patient with small cell lung cancer and a pericardial effusion?
KPS should be factored into all clinical decisions regarding patients with small cell lung cancer, regardless of stage. Age should be considered, but is not a contraindication to curative treatment in itself.The staging of SCLC is inherently subjective - "limited to the ipsilateral thorax and region...
Should radiotherapy be utilized in stage IVA NSCLC with a malignant pericardial effusion?
This has come up on occasions. I'm not aware of any high-quality evidence to guide one way or another. I would say, there may be a role for thoracic RT on a case by case basis. Though, I would preface all of this by stating that malignant pericardial effusion usually confers a poor prognosis.I assum...
How do you balance target coverage vs cord constraints with spine SRS?
In general, balancing competing target coverage and OAR exposure considerations is always a risk/benefit proposition. Having a marginal failure where you sacrificed coverage to meet a constraint associated with a <5% complication rate is always cause for regret. If a cord constraint cannot be met wi...
How do you work-up and manage a patient with prostate cancer and a borderline enlarged pelvic lymph node?
My approach in this case is to start patients on ADT(and abiraterone if possible) and monitor for LN response with a 3mo CT scan. If LN shrinks, I consider them to be N+ and treat the pelvis, boost the LN if it is still of adequate size to do so (typically >5mm), and continue ADT for 2 years before ...
How do you treat encapsulated papillary carcinoma of the breast after lumpectomy with negative margins?
Encapsulated papillary carcinoma behave like DCIS and we use the same principles as we would use for managing DCIS.
When consolidating de novo oligometastatic NSCLC with initial hilar nodal involvement, would you still include the hilum if that disease completely responded to induction chemotherapy?
If the patient had oligo-met before induction chemotherapy, I would consider to TX all previously involved sites. However, if the patient has oligo-met after induction chemotherapy but had poly-met before chemotherapy, I would only TX active residual disease.