Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is post-operative radiation therapy indicated for a sigmoid colon cancer above the peritoneal reflection status post resection with operative/pathology findings of positive lymph nodes below the peritoneal reflection?
Yes.
How would you approach a patient with progressive muscular dystrophy affecting the pharyngeal muscles who needs treatment for a p16 positive base of tongue cancer with bilateral neck disease?
Deescalate.
How would you treat low grade primary breast Leiomyosarcoma following lumpectomy?
Limited data. I would favor a wider margin as the current margin is less than 1 mm and favor re-excision. After surgery, I have used the principle of organ/limb preservation prospective studies on soft tissue sarcoma and offered/considered adjuvant radiation.
Would you offer adjuvant capecitabine in a patient with nasopharyngeal carcinoma who has had cisplatin - gemcitabine induction followed by chemoradiotherapy with cisplatin?
There are now two randomized, published studies in patients with locally advanced nasopharyngeal cancer whereby capecitabine is administered in the adjuvant setting [1], [2]. Both studies demonstrate adjuvant capecitabine improves failure free survival or local control of disease. The combination of...
How do you decide whether to recommend surgical stabilization prior to RT for a femoral neck metastasis?
MIRELS score.
At what heart dose would you prospectively refer a patient to cardiology due to anticipated long term risks?
If a patient had prior BCT and now inflammatory, I would refer given the most likely plan for additional chemotherapy and RT. In general, I refer for cardiac oncology based on a combination of cardiac risk factors (HTN, DM, HLP), family cardiac history, anthracycline receipt, and cardiac dose (ex. I...
What elective areas are you comfortable omitting in the N0 neck for NPC?
Based on the data from China, I would consider omitting levels IV and VB for the N0 Neck.
How do you typically screen for lymphedema in breast cancer patients following RT?
Really this is a clinical issue so I follow women with routine visits and examine them for edema. I don't think there's any role for surveillance measurements or more specific metrics (per hand therapy). The patients tell you when they are concerned. In the era of sentinel node mapping, clinically s...
What precautions or modifications, if any, would you employ when considering lung SBRT for early NSCLC in a patient recovering from acute lung injury?
For a patient recovering from COVID-19 pneumonia, I would hold SBRT until the patient has recovered fully from acute infection, i.e., no more fever, cough, and/or SOB. The patient's breathing should recover to close to pre-COVID-19 pneumonia status and chest CT image showed resolution of COVID-19 ac...
In what N1 H&N patients, if any, would you consider treating the gross disease (primary + involved node) only without elective nodal radiation volume with definitive intent in order to reduce toxicity?
Madness. Not just no but bleep no. I don’t want to injure a lot of patients and discover something stupid.