Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you routinely cover level IA lymph nodes for advanced BOT tumors extending into floor of mouth or oral tongue?
Generally speaking, I would cover any draining nodal region that is at risk based upon the involved mucosal subsite(s). If IA is at risk because of anterior oral cavity disease involvement, I would not omit coverage simply for the fact that the primary originated in another location.
Is there evidence to support partial breast irradiation with daily fractionation?
I agree with @Dr. First Last. Also, there are a number of publications that detail once daily fractionation using external beam delivery. There is a published randomized phase III trial from Florence that used 6 Gy x 5 delivered every other day. I believe this same fractionation regimen has been pub...
How would you manage an early stage HPV mediated pure adenocarcinoma of the tonsil with a large but resectable primary and multiple ipsilateral nodes without clear ECE on imaging?
TORS, neck dissection, and postop RT.
Do you avoid hypofractionated regimen for Grade 3 early stage breast cancer?
The Canadian finding was unexpected and likely not reproducible. Not sure if it will hold up in longer follow-up. START did not find that and I would not withhold hypofractionation based on grade. Whether the boost makes a difference based on grade is pure speculation at this point, but I tend to bo...
Is vocal cord paralysis a complication of thoracic RT?
There have been a few papers demonstrating this with dose to recurrent laryngeal/vagal nerve. Sources below. Kanaoka et al., PMID 37060336 Shultz et al., PMID 25012837 Pierrard et al., PMID 35872055 Carpenter and Rosenzweig, PMID 25436809 Syed et al., Journal of Radiotherapy in Practice 2016
How should a contralateral breast cancer be treated when found during a prophylactic mastectomy?
Whenever a contralateral prophylactic mastectomy is planned, diagnostic imaging of that breast and nodal basin is recommended pre-operatively if not done within the last month or so. Any abnormality should be resolved diagnostically and treated accordingly. Even with this process, incidental cancers...
Would you consider adjuvant RT in an elderly patient with a T1N0 ER+ breast cancer who initially proceeds with endocrine therapy alone and is unable to tolerate it?
Given the low-risk nature of T1N0 luminal lesions among older patients (per the CALGB 9343 and Prime II trials), the conundrum of whether to pursue adjuvant endocrine therapy, radiotherapy (RT), or both after lumpectomy arises with some frequency. Patients who decline RT yet ultimately cannot tolera...
Would you offer bridging radiation before or after leukapheresis?
We believe the ideal time for bridging radiotherapy is after leukapheresis but before CAR T-cell infusion to avoid a negative impact on T-cell collection. However, the clinical situation has to be considered, and if a symptomatic presentation necessitates urgent treatment before leukapheresis, treat...
Would you use SBRT in patients with medically inoperable renal cell carcinoma?
Yes. Together with Drs. @Dr. First Last and Lee Ponsky from University Hospitals Seidman Cancer Center (UHSCC), we have published the first North American trial of SBRT for medically inoperable renal cell carcinoma. The attempt to escalate the dose from 24 Gy in 4 fxs to 48 Gy in 4 fxs was successfu...
When offering APBI, if a patient has invasive ductal carcinoma and DCIS, do they need to fill suitability criteria for both, or does the DCIS criteria only apply to pure DCIS?
In such cases, I use the criteria for invasive cancers. I only use DCIS criteria for pure DCIS.