Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach a young patient with metastatic rectal cancer and a painful local recurrence who underwent chemoRT to 50.4 Gy two years ago and declined surgery?
The answer depends on the anatomy. I would re-irradiate to the GTV only with margin 39Gy in 26fx BID. With a 2 year interval, I would judge that this is not resistant disease and that should buy some more time, but obviously not definitive. I would tell him the only curative option would be to follo...
Does the presence of interstitial lung disease affect your recommendation for BCT vs mastectomy for early stage breast cancer?
I would not use the diagnosis of interstitial lung disease to impact my recommendation for BCT vs. mastectomy. For low risk cases, one can omit RT. In other early stage cases, APBI can be used to reduce lung dose. For locally advanced cases, if the patient can tolerate DIBH can be used or tighter ta...
Do you regularly utilize antiemetic or GI prophylaxis when treating abdominal sites with SBRT?
I regularly use antiemetics for patients treated with SBRT for pancreatic cancer and selectively for patients with liver metastases or hepatocellular cancer. I am agnostic about the antiemetic choice, often the patient has either ondansetron or prochloperazine already; and I ask them to take it 30-6...
What would be your recommended target volume for a high-risk head and neck cutaneous squamous cell carcinoma with microscopic (not clinical) perineural invasion and negative sentinel node biopsy?
That is a good question. Our pathologist takes perineural involvement one level further by describing the nerve involvement as either being small or large nerves. If small cutaneous nerves are involved I make certain that my margins are at least 1.5 cm beyond the clinical tumor margin. If a large ne...
Would you recommend local therapy for a residual breast tumor after chemotherapy following CR of distant disease in a patient with metastatic disease?
Palliation is one clear indication for treating a primary breast tumor in a patient with metastatic disease and may be considered if the tumor is fungating, painful, and/or bleeding. The second potential indication, which is likely the intent of your question, is to improve long term disease control...
How would you treat a patient with a refractory primary splenic marginal zone lymphoma with symptomatic splenomegaly (20 cm) and a mild pancytopenia?
Radiation therapy is utilized in two primary settings to palliate symptoms of splenomegaly in patients with hematologic malignancies.First, extramedullary hematopoiesis within the spleen can lead to symptomatic splenomegaly in a variety of hematologic malignancies (e.g., myelofibrosis). In this sett...
Are there local control and/or toxicity differences between multi-catheter interstitial versus balloon catheter techniques for APBI?
There are no randomized comparisons to guide local control outcomes between the two. That being said the local control rates are comparable in series evaluating interstitial (Hungarian trial, GEC-ESTRO) and prospective balloon/applicator (MammoSite Registry). B39 allowed for both but no data has bee...
How do you prevent non-healing ulcer when treating patients with cutaneous SCC of the distal lower extremity who have peripheral vascular disease?
@Dr. First Last points are well taken but he does not mention dose fractionation. For most skin cancers, I usually treated with a fairly short course of RT , e.g. 400×10, but not in this situation, where a longer course, e.g. 60-70 Gy in 2 Gy fxs may be desirable.
Is it acceptable to omit post-lumpectomy radiation in an elderly patient with recurrent, ipsilateral breast cancer but low risk features?
In terms of omitting post-lumpectomy radiation, its about assessing risk. If this is a recurrence in the same area or proximity ("true recurrence"), I would consider RT in light of recurrence particularly if time from original diagnosis was short. If this was a recurrence in another quadrant or dist...
What is your recommended surveillance imaging routine for a patient with an esthesioneuroblastoma following adjuvant radiation?
My surveillance strategy is: First followup PET and MRI at around 4 months. Follow up with HN surgery and rad onc every 4 months. Repeat imaging at 6 months. Repeat imaging yearly or if needed.