Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a recurrent chest wall desmoid tumor?
Generally for desmoid tumor, we reserve RT for two situations (1) as preop for recurrent desmoid tumor where resection is planned typically to 50 Gy in 25 fractions similar to STS or (2) as definitive treatment for symptomatic/progressive unresected tumors, typically to 58 Gy. Because the difference...
What is the role of neoadjuvant breast radiation in patients with triple negative breast cancer progressing on AC-T?
There is no standard treatment in this setting. If a patient is not a candidate for clinical trial, we have been doing RT with concurrent carboplatinum or xeloda with the hope of making the disease operable. In our experience, response is mixed with a set of patient making it to operable stage.
Do you ever consider local therapy to oligometastatic hormone-receptor positive breast cancer?
Surgery or radiation therapy in metastatic breast cancer patient is one of hot topics in care of the patients with stage IV disease, especially since the survival of oligometastatic breast cancer and widely spread metastatic breast cancer is vastly different. For instance, the 5 year survival of oli...
Do you routinely offer adjuvant whole pelvis and/or extended-field radiation therapy for lymph node-positive undifferentiated uterine sarcoma with positive pelvic and para-aortic lymph nodes, respectively, after complete surgical staging?
This is such rare scenerio that I have not seen in practice with both pelvic and pa node positive. These is aggressive disease with high risk of systemic and local failure . Our approach for undifferentiated sarcoma is sytemic adjuvant chemo and discuss pros and cons of RT with no good evidence to s...
How would you manage papillary variant squamous cell carcinoma of the oropharynx?
We prefer to approach papillary variant squamous cell carcinoma with a surgical approach. These cancers can be related to HPV (either high risk or mucosal subtypes) and generally carry a good prognosis. A selected neck dissection should be considered and if the tumor is larger or more invasive than ...
What brain surveillance imaging frequency do you recommend for SRS patients as they reach beyond a year of disease control?
Regarding brain metastases patients, I think surveillance would depend on the primary disease site and extracranial disease control/progression. We typically repeat MRI Brain scans every 2 to 3 months during the first year and afterwards perhaps surveillance may be less frequent but this would depen...
How do you approach the use of whole brain radiotherapy in a patient who has previously received 2 or more courses of SRS to overlapping sites?
In light of lack of evidence otherwise, I am hesitant to modify my treatment dose or field in a patient who received SRS and received SRS again to the same site for failure, that now needs WBRT for recurrent local or distant brain disease. What is clear is that when doing so, there is anecdotally a ...
When do you hold radiation for moist desqumation to recover when treating breast cancer?
This happens very rarely during the course of RT in the era of hypofractionation and dose homogeneity radiation delivery. In the rare case it happens, we switch to boost rather than giving a treatment break from RT
When do you use amifostine in head and neck cancers?
In our practice we have not used amifostine for at least 6 years. The toxicity associated with amifostine, improvements in radiation conformality, and decreased PTV expansions have all contributed to this change in use.
Would you recommend APBI in an otherwise suitable candidate who is undergoing chemotherapy?
I would offer patients APBI in otherwise suitable patients who are undergoing chemotherapy. I discuss with medical oncologist to ensure treatment is sequenced with RT first but have not used the receipt of chemotherapy as a contraindication. Additionally, patients may not know whether they will be r...