Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What group of patients is suitable for breast radiation using high tangents?
I could consider high tangents for patients with ER+ disease and N1mic. If patients have ER- and N1mic or N1 disease with macromets, I tend to add RNI.
How would you post-operatively manage a peripheral stage I small cell lung carcinoma s/p upfront wedge resection with an R1 microscopic positive margin along the staple line and visceral pleural invasion?
I would advise 4 cycles of chemotherapy followed by immunotherapy. It would be hard to define a “reasonable radiotherapy target” with visceral pleural involvement and surgical suture line, which is true in NSCLC as well. I would not recommend thoracic or prophylactic cranial radiotherapy.
Is there data, or even anecdotal reports, of cosmesis or capsular contracture of a previously augmented breast after lumpectomy and hypofractionated whole breast radiation?
So, you will probably encounter more people who admit to being abducted by UFOs than using HFRT in someone with a cosmetic or reconstructed implant. I've even heard people argue that they go at 1.8Gy/fx as opposed to 2Gy "just to be on the safe side" with regard to capsular contracture. The fact of ...
In the era of neoadjuvant chemotherapy, how reliable is biopsy for assessment of LVI to make decisions about PMRT?
If bx is negative for LVI and final path is negative after NACT, then would not speculate about the possibility of LVI as risk factor for PMRT decisions.
What is the best radiation dose to treat primary cutaneous B cell lymphoma?
For a small (1-2cm lesion) of these subtypes, 30Gy is usually adequate. For larger/thicker lesions, consider 36Gy. Electrons with bolus or orthovoltage/superficial therapy.
What is the shortest interval you would consider to deliver re-irradiation for a recurrent glioblastoma?
Re-irradiation (assuming infield local progression) doesn't usually get discussed until more than 6 months following initial radiation therapy, likely because any increase before that is going to be possible pseudo progression. But after that point if there is increasing contrast enhancement suspici...
What is the best dose to treat splenomegaly with pancytonenia in the setting of myelofibrosis?
I have treated occassionally and have recommended 20 cGy to 25 cGy alternate day x 3 or 4 fractions It works well as spleen is a very radiosensitive organ and does not require doses above 150 cGy
How do you choose between moderate hypofractionation vs SBRT for intact low or intermediate risk prostate cancer patients?
In low-risk prostate cancer patients, hypofractionated regimens have been proven to be equivalent to standard fractionation in randomized studies (e.g. RTOG 0415 - Lee et al., PMID 27044935). Mulitiple non-randomized studies have shown that SBRT appears to have comparable results to historical contr...
How would you treat a p16+ small cell neuroendocine tumor of the anal canal with or without metastatic inguinal lymph node metastasis?
Interesting case. Small cell cancers are generally considered radiosensitive, but so is anal squamous cell carcinoma. I personally would do the same RT field and dose. The real conundrum for me is the concurrent chemotherapy regimen - do you keep 5FU/MMC or do you use cisplatin/etoposide? I think a ...
How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?
Engage your Pulmonology colleagues to assist in these difficult cases. Important to rule out other causes of persistent symptoms including infectious processes. Rebronch can be helpful for infectious work up and/or determining the nature of the inflammatory process that is ongoing (for example, the ...