Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you take any precautions of plan radiation therapy differently for a patient with head and neck cancer who has active Bullous Pemphigoid in the mucosal area that will be radiated?
I have no idea. Probably not. I would roll on and, hopefully, not regret it.
How do you treat an early stage breast cancer with cN0 but could not undergo a SLNB?
I almost always treat these patients with high tangents including lymph node levels 1 and 2 in the tangential beam. There are multiple studies showing excellent regional control with this approach.
What is your approach to management of a myxopapillary ependymoma of the conus with drop metastases to the cauda equina?
Usually I treat with localized fields but feel there is no correct answer. I offer the patients CSI as an alternative and explain benefits and risks. These patients are expected to live very long lives and 36 Gy CSI will have tremendous adversely affect on them. I acknowledge the risk of re-irradiat...
Do you have indications for adjuvant radiation in H&N cancers (oropharynx, oral cavity etc.) other than listed in the NCCN guidelines (ECE, positive margins, pT3/4, N2/3 or Lv IV/V, PNI, LVSI)?
Yes
In what instances would you use bolus for locally advanced vulvar cancer using IMRT?
We always start and plan with bolus for vulvar cancer for two reasons:For bringing up skin dose, and for creating flash to account for set up uncertainty and vulvar swelling.We create an IMRT plan with and without bolus in the beginning (both have flash built in).If the lesion is endophytic, then we...
Would you recommend RNI for a triple negative cancer s/p lumpectomy and ALND with low LN positivity rate?
My current practice is to offer patients with triple negative disease and positive nodes after ALND RNI with their whole breast irradiation. MA20 included such patients with roughly 85% having 1-3 LN+ and more than 65% had 10+ LN removed. The addition of RNI increased survival in ER- patients (81 vs...
Would you offer adjuvant radiation for a <1 cm preauricular sebaceous carcinoma after wide local excision?
I limit the use of postoperative radiation therapy to those cases where there is a moderate likelihood of residual tumor that could develop into a clinical recurrence. In this case, I would have expected the shave biopsy to have positive margins. The lesion was then widely resected by a competent EN...
Would you give post-operative radiation therapy and/or chemotherapy after an APR for anal cancer if inguinal lymph nodes were involved but margins were negative?
This question has medicaolegal implications. We should not try to make up for the bad decisions that others have made. Since the standard of care was not followed, I would be hesitant and careful about causing any significant risk. Elective radiation to the inguinal areas would put the patient at ri...
At what dose would you recommend future audiogram screening for pediatric patients treated with radiotherapy?
I would refer to the COG Late Effects report on Auditory Late Effects (PMID: 20194279). This reference has many relevant papers in its citation list that would aid the evaluation of hearing in specific childhood cancer patient populations. They recommend audiologic evaluation including air and bone ...
How do you approach a patient with locally advanced head and neck cancer requiring chemoradiation that needs extensive dental work from an oral surgeon, but because of insurance and social issues cannot feasibly get the teeth removed?
Treat them. Teeth won’t kill them, the cancer will.