Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient who had childhood sarcoma treated with surgery and chemotherapy but without radiation, would this history impact their risk of second malignancy from radiation to a new cancer given as an adult?
Absolutely. Recent data from SJLIFE suggests that the cumulative incidence of developing any subsequent cancer can still be high among patients treated without radiotherapy, if the patient is a carrier for known mutations characterized by a well established monogenic cancer risk with high-low penetr...
When sending patients for follow up chest CT's after SBRT or chemoRT, how do you determine whether to send for scans with or without IV contrast?
My rule for lung SBRT has been to minimize the use of contrast given the patient population we are treating (elderly, frail, and a desire to minimize kidney stressors), and the fact that we are following lung parenchymal lesions which are generally well visualized without contrast. I also have never...
Would you give full post-operative dose radiation for an undifferentiated high grade pleomorphic sarcoma of the extremity with close surgical margins if the patient had previously received <20Gy preoperatively?
The following response was drafted together with @Dr. First Last:We would offer post-operative RT to 50 Gy via shrinking field technique, delivering 34 Gy to a CTV1 similar to that given pre-operatively (as described below, because of the pre-operative RT, the post-operative CTV1 does not need to in...
In the management of the primary site in high risk neuroblastoma, is there a role for a cone-down to residual disease (boost), following treatment of the post-chemo, pre-surgical extent to 21.6 Gy?
Patients who were enrolled in ANBL 0532 who received a 14.4 Gy boost to the primary site were compared with patients who received no boost enrolled on COG A3973. Five year CILP (cumulative incidence of local progression), EFS, and OS were the same between the two groups of patients. This was present...
How do you approach the decision of whether and when to initiate therapy in patients who remain COVID-19 positive >2 weeks after infection but are asymptomatic from the virus?
If the patient is asymptomatic or minimally symptomatic, we have elected to initiate therapy for the patient. We have treated the patient in full PPE at the end of the day with no other patients in the clinic. Efforts should be made to minimize patient contact throughout the clinic. We have the pat...
How should patients be selected for metastatic-site directed radiotherapy in rhabdomyosarcoma?
Definitive therapy to sites of metastases at the time of diagnosis is recommended for all patients with metastatic disease on the most recent COG trials (both ARST1431 including intermediate risk patients and ARST0431 including high risk patients). We typically treat the metastatic sites at the end ...
When treating an intact whole breast using breath-hold technique with a planned electron boost, do you generate a separate plan for the boost with a free-breathing scan, or plan the electron boost on the breath-hold scan, but treat free-breathing?
It is our practice to acquire a free breathing and breath hold scan. I evaluate the boost plan on the free breathing. The "plan sum" is on the breath hold, but I would be reluctant to not have the free breathing for evaluation of dose, particularly on the left side, as the cardiac displacement may s...
How do you manage dental extractions in a patient getting reirradiation to the mandibular area?
Taking into account the poor prognosis of re-irradiated HNC (for example, Ward MC et al, Oral oncology 2019, reported in a recent 9-institution study of more than 500 patients, cancer progression or death in 64% after re-irradiation), teeth/mandibular damage risk is a moot issue. If cancer is eradic...
How would you approach a locally advanced, node positive oral cavity squamous cell carcinoma of the H&N with cCR after induction chemotherapy?
I would use consolidative full-dose chemo-RT to the pre-chemo CTVs. I would not reduce the extent of the CTVs or treatment intensity. Before the TPF era, randomized studies of induction followed with RT vs RT alone in HNC did not result in improved outcomes in the induction arms, despite achieving a...
Would you consider post-operative radiation therapy for resected malignant melanoma with in-transit metastasis?
I don’t know of any evidence that RT is helpful in this situation.