Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer memantine for cognitive preservation to glioma patients?
I do not as there is currently no evidence to support this. There was a trial conducted by the RTOG for whole brain RT patients with mets which demonstrated a trend towards improvement in time to cognitive decline (53.8 % at 24 weeks for memantine vs 64.9 % for placebo), executive function at 8 and ...
Is dyspnea without radiation pneumonitis a side effect of lung radiation?
Thanks for the interesting question. I would want to know: on what basis are we saying that the patient does not have radiation pneumonitis (RP)? I am going to assume that this is being stated since the imaging findings are underwhelming in this case. Assuming that this is the case, I would answer: ...
How would you design chest wall boost in a patient who underwent mastectomy with a Wise-pattern incision?
Great question. We've all dealt with this scenario clinically. I'll first point out that there is no prospective data for use of chest wall boost in the post-mastectomy setting. The most common location of recurrence following mastectomy is the flap skin, and the most common subsite, but not always,...
What is the appropriate timing for adjuvant radiation for vulvar cancer?
You follow the same principle as other squamous cell cancers to start within 6 weeks for surgery but sometimes are limited by post-op healing. Ashmore et al., PMID 33500149
How would you delineate or modify target volumes for stage I NSCLC abutting the chest wall in a thin patient for whom the traditional SBRT PTV margin extends to the skin?
Truncate the PTV. Evidence is Keane et al., PMID 33239160.I am surprised that a PTV margin would extend all the way to the skin surface even for the most peripheral lung lesion. The rib and chest wall diameter for the patient in question must be exceptionally thin (diameter <=5 mm)?
What is the current criteria for sentinel node biopsy over a full axillary lymph node dissection in a patient with breast cancer?
This is a rapidly evolving space.For patients that cN0 with 1-2 or 3 SLN+, ALND can be omitted without gross ECE. Also, the NCCN guidelines have allowed for a similar approach with patients with 2 or fewer nodes on imaging/biopsy. While most patients on AMAROS/Z011 had breast conservation, this appr...
How do you manage pT1-2N0 p16+ tonsil cancer treated with TORS and ipsilateral negative neck dissection but with positive margin?
This would be a very unusual situation, especially if the Q is in reference to the palatine tonsil. A well trained Robotic surgeon generally would not have any problems with performing a Radical tonsillectomy for an early stage tonsil primary. The superior constrictor and the pillars (ant+post) form...
Would you consider PBI plus covering the regional lymph nodes for a LN+ breast cancer in the remnant of the axillary tail?
Was this patient cN0 and had a positive SLN or did they have an ALND? In the setting of a cancer following prophylactic mastectomy (sounds like the original cancer was contralateral) with a positive node, my preference would be to cover chest wall + RNI. I would say that PBI covering regional nodes ...
Should patients with muscle invasive node negative bladder cancer wishing to have bladder preservation receive chemoRT alone or neoadjuvant chemotherapy followed by chemoRT?
The best evidence that we have does not support neoadjuvant chemotherapy before chemo-RT for bladder cancer. One RTOG trial, admittedly underpowered, and the MRC meta-analysis suggest that, while that benefit may exist for cystectomy, it either doesn't exist or is simply too small to detect for chem...
What role does radiation plan in a pT1a endometrial cancer with two small metastatic foci in the abdomen found during surgery?
I see the limited value of prophylactic RT here and favor systemic treatment only.