Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you balance the need for wound healing and time to treatment initiation in head and neck cancer patients who require a second operation?
Avoid situations where you need a second operation, do the second operation after RT if possible, or do the second operation and start RT within 4 to 6 weeks and accept a higher likelihood of recurrence.
Should we be shrinking rectal cancer fields?
I think this is a good point. However, I think we need to consider the nuances of the question. First PROSPECT included: patients that "had cT2N+, cT3N-, cT3N+ rectal cancers deemed appropriate for neoadjuvant therapy prior to low anterior resection with TME. Patients with distal, T4 tumors, threate...
Does the risk of bowel complications change in a case where there is bowel invasion in a non functioning portion of sigmoid after diversion in a gynecologic malignancy getting CRT + brachy?
The type of bowel complications would define the risk of being symptomatic. Diversion will help with the future risk of fistula but the patient can still develop symptomatic necrosis. That being said, I would prioritize cure in this situation as persistent disease would cause more symptoms.
Do you ever treat a recurrent breast cancer with RNI alone rather than chest wall and RNI?
As this is a de novo case and not a recurrence, it would be reasonable to treat the nodes and leave the chest wall alone given the small size, absence of LVI, and adequate margins.
How do you approach an elderly patient (~80 years) with stage IIC melanoma post resection with oligometastatic brain lesion post intracranial resection which developed 2 years after treatment?
If I am understanding this correctly, then all known metastatic recurrence has been resected.In that case, I recommend cyberknife/SRS to the surgical cavity followed by single agent anti-PD1 therapy. Concurrent administration of anti-PD1 with SRS or GKRS is experimental at this point. There is no co...
What radiation dose-fractionation regimen would you choose for squamous cell carcinoma of the great toe in a patient who declines surgery?
I've had good results with 35/5 QOD. 36 in 6, 2 fx a week is good, too. There is another similar thread: https://www.themednet.org/question/2647.
Do you offer neoadjuvant radiation therapy for oral cavity sarcoma?
Rare situation. Be sure the path is unequivocal (and not e.g., a sarcomatoid SCC, which is not at all a sarcoma). If it really is a sarcoma, preop (50 Gy/25 fx with sarcoma expansions) is reasonable if your surgeon is comfortable with it, but oftentimes there is less familiarity/comfort with preop R...
Would you offer radiation for Stage III NSCLC in a non-surgical candidate with prior post-mastectomy chest wall RT?
Yes, I would offer definitive thoracic radiation (60 Gy standard fractionated) to a patient with prior h/o postmastectomy chest wall radiation, even if the lung cancer is on the same side as the irradiated chest wall. Likely the dose to the chest wall was around 50 Gy. If there were any areas of che...
How will you manage a patient with symptomatic secondary CNS involvement from DLBCL not eligible for HD-MTX?
Patients with secondary CNS lymphoma have historically had a very poor prognosis. Depending upon circumstances, many patients today are treated with a chemotherapy regimen that penetrates the blood-brain barrier (e.g., MATRix). If the patient responds favorably and is fit, high-dose chemotherapy fol...
Does an EGFR mutation in a never-smoker change your radiation treatment recommendations for ES-SCLC?
First, worth a close pathology review at a specialty center. EGFR mutations in de novo small cell are exquisitely rare. The more common scenario is small cell transformation from adenocarcinoma. If this has features of adenocarcinoma, I’d favor a metastatic non small cell paradigm with EGFR inhibiti...