Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you boost a positive margin (R1 resection or R2 resection) in a GEJ esophageal carcinoma that completed neoadjuvant chemoradiation?
Theoretically this might be feasible if it is a radial margin and not a mucosal margin because the irradiated mucosal structures would have been resected. There is no evidence-based answer to this question and I'm sure there are people that feel that further radiation is indicated. Not all patients ...
What is your approach to young healthy women with locally advanced breast cancer and biopsy-proven low cervical lymph nodes?
At this point, we treat them with definitive intent as most often these low cervical nodes are level 4 or adjoining level 5 node which by definition are supraclavicular nodes (often radiologists call them as cervical nodes but one needs to see images to confirm location). A subset of patients with t...
Would you consider upfront chemoradiation therapy for a patient with metastatic anal squamous cell carcinoma if they have a large burden of disease at the anus?
There aren't many good systemic options for metastatic squamous cell carcinoma of the anus. In cases of significant local symptoms, I plan a definitive treatment using definitive dose with 5FU and cisplatin (mitomycin C may also be acceptable). This way, I have the option of giving full dose but the...
Would you treat Vaginal intraepthelial neoplasia 3 with HDR brachytherapy?
This is an option for persistent VAIN3 despite surgery and topical agent I have treated with 6 Gy x5 Important principal is where you are presecribing dose. Previous HDR studies have shown high complications because entire length was treated to fixed depth of 5 mm or so. The vaginal wall thickness v...
What is your approach to treating early stage EBV-positive diffuse large B-cell lymphoma of the elderly after a CR to systemic therapy?
EBV+ diffuse large B-cell lymphoma of the elderly, which typically affects apparently immunocompetant individuals > 50 y/o, was a provisional diagnosis in the 2008 edition of the WHO classification system. EBV+ DLBCL has been recognized in younger patients which led to a revision in the 2016 classif...
Does your institution omit prophylactic cranial irradiation in high risk ALL patients greater than 3 years of age?
The general trend worldwide has been to continue to reduce the proportion of patients receiving preemptive CNS directed radiotherapy, although some groups still utilize cranial radiotherapy in the front line setting for small subsets of patients with CNS3 disease at diagnosis, T-cell immunophenotype...
How would you treat HGIL in a woman with a history of early stage endometrial cancer?
It needs to be assessed by eua and biopsies. If only HGIL confirmed by bx, management needs to be conservative treatment like surgical excision and /or laser therapy.
How do you approach treatment of a locally advanced primary tongue SCC lesion spanning oral cavity and base of tongue?
I classify site based on bulk of disease. ChemoRT for tongue base and surgery and postop RT for oral tongue. If it’s too extensive to distinguish, which is infrequent, chemoRT, particularly if total glossectomy would be required.
How do you approach a peripheral, T1 lung cancer with a positive mediastinal node by EBUS?
I agree with @Dr. First Last's thoughtful response above. Though the idea of SBRT to a small primary is appealing, the clear standard of care here would be to deliver concurrent chemoradiation using standard fractionation (i.e. 60Gy) using standard margins and standard approach to nodal irradiation ...
What are the recommended treatment fields for desmoid tumors?
There is great clinical equipoise on how to treat desmoid tumors with radiotherapy. I apply general sarcoma princples to the CTV expansions for desmoids depending on their location. I find it helpful to obtain an MR to delineate the extent of infiltration (I am lucky in that I have access to an MR s...