Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel patients on imaging findings after liver SBRT for HCC, particularly with regard to expectations on timing to tumor resolution?
My experience has been that the more successful the treatment, the sooner the patients want the good news. In reality, a well-designed and executed SBRT treatment to an ablative dose should result in 85 to 95% tumor control (mostly size independent) at 2 years with very little local progression afte...
If adjuvant radiation is indicated for a Merkel cell carcinoma of the upper extremity and hypofractionation is desired, what dosing regimens are recommended?
While more common cancers (breast, prostate, etc.) have well-designed clinical trials that demonstrate equivalence of hypofractionated radiotherapy and conventionally fractionated radiotherapy, similar types of studies are lacking in less common cancers like Merkel cell carcinoma. Part of the diffic...
What is your approach to adjuvant radiation for anorectal mucosal melanoma s/p wide local excision?
Primary anorectal melanomas are very rare, thus there are no large randomized trials to guide their care. As with any melanoma, surgery is the mainstay treatment. Oncologic surgery often entails APR leading to permanent colostomy thus local excision is sometimes preferred.Following excision, adjuvan...
How do you manage vaginal necrosis after pelvic radiation?
This is a broad topic that doesn't lend itself to a short answer format; however, I will offer a few thoughts. The first thing, of course, is to keep it from happening through judicious RT technique. Vaginal necrosis is most likely due to brachytherapy administration rather than external beam RT, an...
When is radiation indicated in the treatment of perianal paget's disease?
Extramammary Pagets disease is essentially adenocarcinoma in-situ and typically managed surgically. I would not treat with radiation unless it is invasive. If it is invasive and inoperable or if it would require APR, radiation is an excellent option. I treat them like SCCa of the anal canal, except ...
How would you treat a late local recurrence of extramammary Paget's disease of the vulva, not amenable to resection?
If the patient does not have any invasive disease, or underlying malignancy or nodes, then I would consider treating this with radiation, specifically superficial brachytherapy. At our institution, we routinely treat similar patients with large perineal, inguinal EMPD patients with 3D custom printed...
What radiation dose/fractionation would you consider for palliation of an unresectable vulvar cancer that received previous definitive radiation therapy?
For patients with recurrence after definitive vulvar irradiation, surgery is the best option, if possible.If this is not possible, then the retreatment with radiation can only be palliative to reduce pain or bleeding. Depending upon the extent of recurrent disease - a dose of 3000cgy in 10 fractions...
How would you approach a patient with a 12 mm recurrence of the left implant-based breast reconstruction 17 years after her initial diagnosis?
You haven't indicated what prior Rx the patient has received. Assuming no prior RT, I would radiate the chest wall, probably skip the nodes, and add hormonal therapy again, depending on what she has received in the past.
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
A network of specialists familiar with cSCC is necessary to optimize care that is tailored and appropriate for each unique case. Avoiding under-treatment and over-treatment is important, but also challenging, given the high volume of cSCC tumors with variable patterns of presentation and numerous cr...
Is PMRT considered the standard of care in women with 1-3 positive axillary lymph nodes?
I come to this question with a somewhat different stance than we have traditionally thought. To me, the following things seem clear:1) In our modern randomized trials of PMRT (British Columbia and Danish 82b and c) there was no difference in the OS advantage of RT based on # of positive nodes (1-3 v...