Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dosimetric concerns do you have regarding PMRT in patients with magnetic valve tissue expanders?
This article gives some guidance for dosimetry and plan
What are the clear criteria for unresectability in locally advanced NSCLC patients, other than medical or anatomic?
Unfortunately there is not a clearly defined criteria to answer your question. As you stated much of the debate is centered around what is "resectable N2" disease. Since there is no clear definition of what surgically resectable N2 disease much of these treatment decisions are dependent on individua...
How do you identify immunotherapy-related pneumonitis vs. radiation pneumonitis in a patient status post chemoradiation receiving consolidation immunotherapy?
Unfortunately, it can be quite difficult to discern the two. Radiation pneumonitis is classically more focal within the treatment field, however, it is absolutely possible to get a more diffuse pneumonitis even with focal RT (albeit uncommon).https://www.ncbi.nlm.nih.gov/pubmed/15256622Immunotherapy...
How would you manage an elderly patient with GE junction adenocarcinoma who is not interested in surgery and who has ulcerative colitis (not currently on medication or symptomatic)?
Ulcerative colitis is generally a disease limited to the colon, and is an important distinction from Crohn's disease, which is truly anywhere from mouth to anus in the GI tract. These two diseases are on a spectrum of inflammatory bowel disease and there can be some overlap, but in general I would p...
In patients witih locally advanced pancreatic cancer, how long would you wait after 1st line induction chemotherapy with FOLFIRINOX before you image for assessment of response and deciding about 2nd-line therapy?
We image with Ca-19-9 every 3 months and consolidate with ablative chemoradiation after a minimum of 4 months of FOLFIRINOX. We do not give second line chemotherapy for locally advanced pancreatic cancer unless patients do not tolerate FOLFIRINOX in spite of dose reductions, or experience progressio...
What is your approach to mediastinal-only failure outside of the previous chemo/radiation field for SCLC?
I would treat involved nodal stations with concurrent chemo and radiotherapy. I don't feel it is necessary to cover the whole untreated mediastinum. In terms of margin, I would review the detail CT and PET/CT images and balance the chance of lymph node microscopic disease and toxicities of radiother...
When offering PCI for SCLC patient, do you include C1 in the treatment field or do you stop at the base of the skull?
I do bottom of C1 like most WBRT. I still go to bottom of C2 for LMD cases but I'm not sure that is necessary for PCI. Not aware of any direct level 1 evidence to address this, more of historical practice based on 2D. With FIF and VMAT CSI techniques and better IGRT, ensuring easy match line and fie...
Do you offer APBI to patients with PALB2 mutation who is a suitable candidate?
In our clinic, most patients with PALB2 end up getting mastectomy. However, if they choose to undergo breast conserving therapy, I usually discuss whole breast irradiation and the potential risk of new and contralateral primaries. While, I would not routinely offer APBI to such patients, if they wer...
How do you manage an anal SCC status post a non-oncologic excision of a 2-3 cm primary and positive excisional biopsy of an inguinal node with pathology revealing LVSI, positive surgical margins, and more regional lymph nodes on PET?
This was done prior to the referral for radiation but there is no role for an excisional biopsy of a lymph node and it can be harmful. It changes lymphatic drainage, shifting it to towards the genitalia and suprapubic area. Cells in transit to that nodal basin will now try to get to the other side. ...
How do you approach elderly patients with stage III NSCLC who have a reasonable performance status?
Prior to answering this question, I should be clear that I have no additional geriatric oncology training or expertise other than someone who has treated lung cancer patients for more than 25 years. Generally I approach elderly patients in the same way I approach the younger with the caveat that I f...