Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with early stage breast cancer previously treated with lumpectomy and RT, how would you manage a node positive recurrence s/p lumpectomy and SNB?
I have never done RT in a clinical situation like this. The risk of IBTR with partial breast RT in conjunction with nodal RT is not known. Besides, the risk of morbidity with overlap of nodal RT may be high when combined with previous breast RT with low lying axilla.
How do you sequence short course radiation for locally advanced rectal cancer when using the total neoadjuvant approach?
Short answer: No, there is no data suggesting that this regimen and its longer wait is detrimental to operative morbidity for rectal cancer. Long answer: The concern about the delay from TNT, whether short course radiation->chemotherapy OR chemoradiation->chemotherapy prior to surgery has been addre...
Are there any hypofractionated RT regimens that could be considered in a post-op setting for extremity soft tissue sarcoma?
Especially in the age of COVID-19, this is a relevant question. Although there are certainly hypofractionated regimens studied and employed in the pre-op setting, e.g. 30 Gy in 5 fractions as published by the UCLA group, I'm not aware of any parallel data in the post-op setting.Thus if there's a nee...
How would you manage a centrally located new primary squamous NSCLC after prior definitive chemoradiation to 45 Gy/30 fractions for small cell lung carcinoma?
If it is localized disease with good KPS and there is no option of surgical resection, I would consider definitive chemo/RT to 60 Gy in 30 FX. I would keep the cumulative dose to the esophagus under 100 Gy, bronchial tree under 110 Gy, and major vessels under 120 Gy.
What dose-fractionation would you recommend for post-operative radiation therapy for an excised cutaneous squamous cell carcinoma of the foot with a skin graft?
This is a tricky question. There are several factors I would like to know to recommend post operative RT: 1) What was the location of the lesion, size and histological grade? 2) Any high risk factors such as LVI? 3) I presume the tumor was resected; what is the Path status of the margins? Close, pos...
How would you approach a supraclavicular high grade monophonic synovial sarcoma?
When I see a patient who has had a partial excision of a soft tissue sarcoma, I approach further therapy as I would a new diagnosis. Our preference, in a location where wide surgical resection is often difficult, is to use preoperative RT followed by surgical resection, and that is what I would do i...
How do you manage a recurrent craniopharyngioma?
Complex answer—my personal view based on my Neurosurgery and SRS/RO experience:1. If the recurrence is a single large cyst—surgery (stereotactic aspiration combined with SRS to collapsed cyst immediately, have done the same day) or Intra-cavitary P32.2. If it's a small solid/micro-cystic recurrence—...
How do you approach a patient with ATM mutation with prostate cancer?
This is a good guide for a radiation oncologist suggesting no contraindication to RT, with a possible small increase in second cancer (most data based on breast cancer).
Would you consider APBI in a patient who received neoadjuvant chemotherapy?
I do not consider APBI in patients who have received neoadjuvant chemotherapy. While I am aware that some do, I do have concern regarding encompassing volume at risk. With more patients receiving neoadjuvant endocrine therapy, this is also an area where we don't have great data. I have not tradition...
Do you ever boost equivocal pelvic lymph nodes in a patient with low PSA who will get salvage XRT?
The question has two spins to it. Do we do it? Probably yes, as it's easy to do without much morbidity, if treating the pelvis to begin with. Does it help? We don’t know, as reactive nodes are not uncommon in the pelvis. Once PSMA scans are available, one would have a better estimation of nodal dise...