Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How does avascular necrosis of the femoral head affect definitive radiation to the prostate?
I asked the question and have no long-term follow-up to draw on to answer it. For what it is worth, I will summarize below what I learned from discussion with one experienced orthopedic surgeon, plus some reading. If others have insight/comments/opinions, please share! AVN is irreversible. Risk fac...
Is there a reliable way to distinguish a metastasis from a secondary primary tumor if the histology is the same?
This issue may arise when a single lung lesion is found in a previously treated HNC, where distinguishing between a small secondary lung sqcca vs metastatic HNC have significant implications. A comparison of typical molecular characteristics in the primary and the secondary is a possible way. For ex...
Why is accelerated hyperfractionated RT still being performed in NRG trials such as HN005?
To go back a little bit in history, RTOG 1016 was designed prior to the results of RTOG 0129 were available. In the Bonner trial, most patients were treated with accelerated fractionation + cetuximab, and seemed to have better outcomes than those with conventional fractionation. Therefore, in the ab...
How do you deliver appropriate bilateral post-mastectomy radiation therapy for a young woman with a bilateral clinically node-positive lobular breast cancer with a pacemaker in place?
One has to prioritize and plan based on absolute benefit and would skip RNI on the side patient has pacemaker.
If colostomy is indicated prior to Nigro for locally advanced anal SCC, would you wait to simulate after this procedure or do you feel pelvic anatomy will not be distorted?
No reason to wait.
Do you crop the mediastinal nodal CTV out of normal lung parenchyma when treating locally advanced NSCLC?
I do routinely crop the mediastinal CTV out of lung parenchyma—while a node may physically expand into the lung tissue (displacing the lung tissue)—there should not be microscopic invasion of the parenchyma. I similarly shave this nodal CTV out of other mediastinal structures such as bone, esophagus...
Are you routinely considering treating p16 positive, nonsmokers, occult primary with pharyngeal sparing technique in patients who have undergone extensive TORS workup?
Sparing the pharyngeal constrictors in unknown primary cases should not differ from standard practice in which only the lateral RPN nodes are considered at risk. The only cases where the medial retropharyngeal nodes are at risk (which would prevent constrictor sparing) are cases of posterior pharyng...
In light of the COVID-19 pandemic, would you consider SBRT for appropriately selected early stage breast cancer patients?
No.If I'm interpreting the question correctly, it poses using definitive/ablative SBRT in lieu of breast surgery. There is no high level evidence to suggest that this is as efficacious as initial surgery. Definitive breast SBRT is being very actively studied in many smaller Phase I/II.While some ret...
How do you approach treatment for a patient who develops a nodal recurrence years after primary resection of NSCLC?
I agree with @Dr. First Last's approach re mediastinal relapse; we consider delayed limited nodal relapse as a manifestation of microscopic disease that has had the opportunity to manifest itself, and the implication would be that this was Stage III disease to begin with, and our salvage strategy th...
How do you distinguish between radiation necrosis, abscess, or disease recurrence in head and neck cancer patients?
This is a difficult clinical situation. I find physical exams including laryngoscopy to be of most use. If there are sharp borders and ulcers are soft with signs of infection, I will more likely suspect necrosis with super-infection. In this case, I will try antibiotics, antifungal, and antiseptic m...