Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What can be done to help rehabilitate trismus secondary to radiation and surgery?
Physical therapy. Stretching exercises. If present prior to treatment, it is unlikely to improve. It will likely be a chronic problem.
For insurance, how do you justify medical necessity for IMRT to the pancreas in the preoperative, unresectable, and post-operative settings?
I work in prior auth. In all three cases, IMRT would be auto-approved where I work. Other third parties are restrictive about this and it is unclear to me why. In any case, though it is burdensome, if I was in a region that was restrictive, I would do a comparison plan right off the bat. As annoying...
Would you offer empiric radiation for a growing mediastinal mass radiographically suspicious for thymoma in a patient who declines surgery?
If the patient truly refuses surgery, they need to undergo a core biopsy to get a tissue diagnosis due to the variety of potential histologies (ranging from thymoma, thymic carcinoma, lymphoma, germ cell tumor, primary lung tumor, etc.) each requiring distinct management strategies. Even...
Do you routinely obtain a spine MRI for all patients planned for palliative spine RT?
If the treatment plan involves conventional EBRT for palliation of painful spine metastasis, reasonably identified on other imaging and correlating with the patient's location and nature of pain, I believe an MRI may not be necessary. However, if there are symptoms indicative of epidural spread or n...
How do you approach breast RT in a patient with a recent history of ipsilateral thoracic irradiation?
When patients have two simultaneous cancers, it is necessary to carefully plan the treatment strategy from the beginning in order to maximize the chance of cure of both cancers with the minimum possible toxicity. It is not clear what kind of surgery this patient had for her breast cancer, nor why th...
What are your thoughts on the relevance of sentinel lymph node biopsy before the onset of neoadjuvant chemotherapy for HER2+ or triple negative cT2+N0M0 breast cancer patients?
We don’t favor SNLN bx upfront as systemic agent is the same for the two phenotypes for T2 and the above disease and will tailor the RT field based on the final pathology.
For patients with recurrence or second primary in the head and neck after prior radiation, what would be the postoperative indications for adjuvant radiation?
This is a very complex situation where multiple factors are weighed in the decision to give postop re-RT. In general, patients with positive margin and ENE. We're currently waiting for Dr. Zandberg's ECOG 3191 trial results to give us more answers.
For a localized vaginal cuff recurrence of uterine leiomyosarcoma, what is the preferred management strategy?
I would favor surgery if feasible (upper vaginectomy is also sometimes an option) and if not, can try induction chemo or preop RT to make it resectable.
Would you offer treatment according to the PROSPECT trial for rectal cancer in which an involved lymph node approaches the circumferential resection margin (CRM)?
Yes, if the goal is fertility preservation. One can start with Folfox chemotherapy and restage afterwards. If good response and the CRM is clear then proceed with surgery and if not, you can discuss doing chemoRT at that time.
What are the current indications for proton beam therapy in the treatment of breast cancer?
Proton therapy can often be helpful in locally advanced breast cancer scenarios when the proximity of targets (e.g. internal mammary nodes) may approximate vulnerable cardiopulmonary structures or where other normal tissue exposure may be a concern. This can be applicable among patients with: Unfavo...