Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How does residual DCIS after neoadjuvant chemotherapy impact prognosis if there is a CR of the invasive disease?
The majority of studies suggest residual DCIS has the same outcome as pCR with no invasive disease and thus is still treated as pCR in practice.
Would you consider pelvic radiation in a patient with prostate cancer and myelofibrosis with mild cytopenias?
I would avoid prophylactic RT in this scenario as the absolute benefit has to be weighed against the worsening of cytopenia.
How would you approach management of a patient who is status post resection of a WHO grade 1 planum sphenoidale meningioma which was adherent to the optic nerve?
As suggested by the mere fact of its posting, this is a complex question. If this were a gross total resection (GTR), I would tend toward observation and would follow the patient carefully with imaging and clinical evaluations at 6-month intervals for at least 3 years, then annually. GTR for a planu...
For an atypical meningioma WHO grade 2 s/p GTR, do molecular findings that suggest an integrated diagnosis of a grade 3 tumor change adjuvant radiation treatment recommendations?
There is no definitive clarity on this question, as the data simply do not exist. Therefore, decision-making has to be individualized. For residual disease, the GTV would be easy to estimate, but it might be prudent to utilize the pre-op scans in these patients to understand the pre-op GTV, which co...
What rates of breast (not arm) lymphedema would you quote to patients post-lumpectomy and adjuvant radiation?
The UK trials report on breast edema and provide helpful numbers for counseling patients. For instance, in the UK IMPORT HIGH trial (hot off the press!), rates of breast edema in the sequential boost arm (40 Gy + 16 Gy boost) were 90% none, 7% mild, 2% moderate and <1% marked. In the lower SIB arm (...
Are there any particular considerations to take when external beam radiation is recommended in a patient who has received RAI before?
No
Would you offer palliative RT for a patient with a pelvic mass fistulizing to large bowel?
I would generally not be comfortable giving palliative irradiation unless the bowel had been diverted, particularly in a patient receiving Avastin. The risk of perforation and sepsis would likely be high. However, if the fecal stream is diverted above the fecal stream and the patient has no evidence...
In patient s/p definitive chemoRT for vulvar cancer with complete response, how do you manage a non-healing vulvar defect if biopsy is negative for residual disease?
Hard and takes time. Vitamin E with trental and quit smoking.
How does a history of radiation pneumonitis impact your decision on future lung SBRT?
There are a lot of factors to consider. Generally speaking, I default to surgery almost always if it's doable with minimal risk/morbidity. Based on the recently updated wedge vs lobectomy (Altorki et al., PMID 36780674), the outcomes are similar between the two which is exciting for parenchyma spari...
When would you include treatment of the entire staple line for an NSCLC staple line recurrence?
I was taught years ago that the whole staple line has been to be considered at risk since it is anatomically distorted and "nobody" knows exactly where the foci of microscopic disease may be hiding. In the scenario where there is a true focus then of recurrent disease on the staple line, I have ther...