Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the significance of entrapped nerves present on pathology for oral cavity cancers?
For oral cavity, surgery and postop RT. For oropharynx, RT chemo. It’s very uncommon.
What is the clinical benefit of primary site postoperative radiation after neoadjuvant chemotherapy and oncologic surgery for an extremity soft tissue synovial sarcoma in an oligometastatic patient with pulmonary metastases ?
Management of oligometastatic soft tissue sarcoma is an interesting problem without a uniform standard of care. Institutionally, we often treat these patients in the following sequence: neoadjuvant chemo, then neoadjuvant concurrent chemoRT to primary site, then consolidate the oligometastatic sites...
Would you offer reirradiation after resection of locally recurrent triple negative breast cancer only 6 months after completion of postmastectomy radiation?
If recurrence is in the prior full dose of RT then get concerned about the efficacy of reradiation when it didn’t work 6 months ago. If it is marginal area or in an area where dosing was inadequate, then yes. Also if have hyperthermia then it would be a good modality to add with reradiation in this ...
Would you offer RT for a patient with early stage breast cancer with a focally positive margin who was lost to follow up for over a year after surgery?
It’s too long of an interval for any benefit of adjuvant treatment. Needs mammogram and follow up along with relevant systemic therapy.
Would you offer PMRT to an ER/PR+, Her-2 negative cT3 tumor treated with neoadjuvant chemotherapy, but with a minimal treatment response?
The data on the risk of local-regional failure and the effect of PMRT on outcome are still too limited and contradictory to be certain of the correct answer. For example, the 10-year risk of LRF in the NSABP series of 95 cT3N0 patients having negative nodes but residual breast disease was 12% (1). H...
Would you recommend PMRT for stage IIA (pT1c pN1a) ER+/HER2- grade 2 IDC in an elderly patient with a single positive non-sentinel lymph node?
This is a patient where given comorbidities you have multiple options. I will often offer these patients 15 fractions to the chest wall with consideration of SCV. It's well-tolerated.
How would you approach the parotid volume for a PET avid intra-parotid node when planning definitive chemo radiation for a locally advanced squamous cell carcinoma of the oropharynx?
Beware Warthin’s tumor! I have a low threshold to biopsy given the quite small (but of course not zero) risk of parotid metastasis in the typical patient.
Would you include interconnecting skin in the radiation volume for a patient with lateral forehead squamous cell carcinoma who will receive radiation to the surgical bed and preauricular lymph nodes?
Yes. It's the interconnecting in-transit lymphatics rather than the skin that is the actual target. Since these are very superficial, an electron field would do the job.
What is your preferred palliative radiation regimen for patients with painful bone metastasis?
Because of the great work of the BM Working Group led by Hartsell et al, and the Dutch, for examples, there are ample category 1 data supporting the use of Single Fraction (800cGyx1) EBRT for "uncomplicated" bone lesions. That is, the use of 800cGy x1 unless there is: a soft tissue component, an imp...
Do you do urethrogram at time of prostate simulation?
We don't perform a urethrogam. We do MRI with a pelvic coil and fuse it with the CT scan which helps to identify the base, lateral edge and apex appropriately.