Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can you skip elective inguinal treatment in PET negative squamous cell carcinoma of anal canal?
This is an interesting question. There are a few small series that suggest that the negative predictive value of a PET-CT may be quite high (100% in the study by Mistrangelo, IJROBP, 2012). However, the gold standard in these results was sentinel lymph node biopsy, not inguinal lymph node dissection...
Can bicalutamide be used instead of LHRH agonist in intermediate to high risk prostate patients receiving EBRT who want to preserve erectile function?
The short answer is yes, BUT with some serious reservations: 1. This is not considered standard of care in this patient population, so patients should be made aware of that fact and that conversation should be documented in the medical record; 2. There are data to indicate that bicalutamide plus EBR...
How do you counsel patients on multivitamin use during therapy?
I tell patients to stop intake of anti-oxidant multivitamins (A,C and E) at the time of consultation, and if they so wish, they can resume them no sooner than 6-8 weeks after course completion because "radiation continues to work after we're done." I simplify how radiation attacks/kills the cancer D...
What do you consider to be the regional nodal bed for a Merkel cell carcinoma of the thigh with a positive sentinel node in the inguinal chain?
There's no clear right or wrong answer here - I would favor treating the superficial and deep inguinal nodes, capturing the chain as it extends superiorly and inferiorly with a generous margin above and below the site of the sentinel node. I would probably include the external iliac nodes if this co...
How would you treat a large-cell neuroendocrine carcinoma of the breast with bulky axillary involvement with good response to neoadjuvant chemo followed by mastectomy/ALND?
I would favor comprehensive treatment as uncommon disease and has poor outcome and would err on side of over treatment
What volume would you cover for HPV-positive SCC of level IB node with ECE?
Depending on the subsite and stage of the primary tumor and nodal stage, we may treat ipsilateral IB, II-IV and contralateral II-IV. We may need to cover IV if there is more extensive nodal involvement in the neck. But if we focus the question narrowly on IB node with met HPV(+) tumor with ENE, for ...
Would you ever recommend PMRT to the chest wall alone without nodal radiation for invasive or in situ breast disease?
In patients who are node negative upfront, I do offer PMRT for adverse primary tumor factors which meets criteria for PMRT to CW only. Retrospective data suggest majority of local recurrence in CW in these pts and can skip RNI
How would you treat a woman with an isolated vaginal cuff recurrence from endometrial cancer who has received salvage resection?
I would still consider for RT as limited data suggest higher nodal relapse if only local disease addressed I would treat pelvis with EBRT followed by brachy boost but to lower total dose of 60 to 65 Gy EQ2
How do you approach treatment of metastatic disease involving the brainstem or cervical spinal cord in the setting of prior XRT?
I would look at this scenario taking into account, not limited to, the overall life expectancy of the patient, performance status, cranial and extracranial disease control. I would want to know the prior RT dose fraction, overlap with current target volume, and interval from the prior RT. Suppose th...
For a patient with diffuse large B-cell lymphoma of the testicle, do you irradiate the contralateral testicle alone or do you recommend radiation to the lymphatics and remaining testicle?
The most common clinical scenario for primary testicular lymphoma is an older man presenting with a painless testicular mass who undergoes orchiectomy and is found to have DLBCL. Many patients will have stage I disease with post-orchiectomy PET-CT showing no other sites of involvement. Occasionally,...