Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach adjuvant therapy for a patient with a single lymph node positive in the peri-prostatic fat without pelvic lymph node dissection?
I would favor treating like node positive prostate cancer adjuvantly with long term ADT and RT. Presuming post op PSA is undetectable.
How would you manage pleomorphic adenoma of minor salivary glands involving hypopharynx/larynx with positive surgical margin?
Postop RT with carcinoma doses.
How would you manage primary breast osteosarcoma?
Osteosarcoma of the breast is a rare and highly aggressive tumor, accounting for less than 1% of all primary breast malignancies. Due to its infrequent occurrence, there is a lack of prospective studies to determine the best treatment approach and most publications are case reports. Instead of focus...
How would you manage de novo oligometastatic NSCLC with an isolated low cervical node metastasis?
I view the presence of an isolated low cervical node as somewhere in between an advanced stage III (since supraclavicular/scalene is N3), and oligometastatic stage IV. In either case, assuming the patient received several cycles of induction systemic therapy without progression, I do believe there i...
Does a transperineal approach to prostate biopsy change your treatment plan compared to transrectal?
The short answer is no. The typical scenario in which I have seen transperineal biopsies done is a patient with multiple negative transrectal biopsies in whom there is still a concern for clinically significant prostate cancer and an MRI has not identified a target to biopsy. In these cases, multipl...
How would you approach a non-healing wound following lumpectomy for recurrent disease in a patient who underwent breast conservation therapy with radiation 10 years prior?
Can try HBO and plastic surgery closure at some point.
What dose volume constraints do you use for APBI using the Livi regimen for rib, contralateral breast and lung?
Marrazzo et al., PMID 35659597 This is our revised guidelines with nothing specific for ribs but with conformity and hot spot restriction, it is driven by part of the rib in PTV and dose criteria for PTV.
How well does left chest wall electron chest wall RT compare with IMRT with with respect to heart and lung radiation doses?
The acute skin toxicity is high, as well as the late telangiectasias. There can also be substantial variation in the skin surface contour of the patient, so really only patients without reconstruction and relatively ‘flat’ profile are suitable. Some have mitigated that by building custom boluses tha...
Is close observation a reasonable option for elderly patients with a small basal cell carcinoma of the face?
Yes, depending on life expectancy, logistics, and morbidity of treatment which would be minimal with RT.
How are you managing patients with H&N cancers meriting definitive concurrent chemoRT during cisplatin shortages?
If cisplatin cannot be used, other systemic therapies should be considered. The NCCN guidelines list various regimens, as noted below. Given the improvements in the delivery and quality of radiation therapy, I am a believer that single agent carboplatin (AUC 6 Q 3 weeks or AUC 2 Q weekly) can be sub...