Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach therapy for a young, fit patient with alveolar rhabdomyosarcoma involving the anterior nasal vault/sinuses in the absence of available clinical trials?
The patient should be risk stratified (as per the Intergroup Rhabdomyosarcoma Study Group classifications) and treated with multimodality therapy, including chemotherapy and likely definitive radiotherapy, depending on the specific location. Surgery is also a consideration, but these are generally c...
Would you consider APBI in a primary breast adenoid cystic carcinoma?
I would be reluctant based on local spread pattern.
What is the management of residual bulky (~ 2cm) internal mammary lymph node metastasis from breast cancer after neoadjuvant chemotherapy?
This is relatively uncommon in our practice. However, if there is residual bulky IM adenopathy after chemotherapy, my first question would be whether or not there might be another systemic agent to consider trying before the patient goes to surgery. I would lean toward this approach when feasible. H...
What CTV margins do you use for indolent advanced stage lymphoma treated with palliative radiation alone?
If palliation for advanced indolent lymphoma, I use 2 Gy x 2 to gross disease with CTV of 0-1 cm. My goal is to palliate the clinically symptomatic disease and nothing more. Dose has virtually no side effects for most sites, and retreatment is possible in adjacent or same sites if needed.
How would you manage a positive deep margin in the setting of mastectomy and expander placement?
With these cases, I first discuss with the patient's surgeon if there is any role for re-excision. If not, then I look at whether it is prepectoral or subpectroal. With a subpectoral implant/expander, the at risk margin is in front of the implant/expander; while with a prepectoral implant/expander, ...
What elective lymph node areas do you cover for T4a rectal adenocarcinoma?
Here's my take: I think the spirit of this convention is really that involvement of more anterior organs raises the risk of external lymph node chain involvement. Visceral peritoneal involvement is certainly a marker for a more aggressive disease and certainly may also mean that the cancer involves ...
Would the presence of diverticulosis change your dose constraint for large bowel?
I have not changed the dose constraint for large bowel with or without diverticulosis. I use 0.5 cc to 33 Gy as my dose constraint, and I would make sure the 'tics are included in the colon volume.
Do you offer consolidation RT to the prostate in patients with extensive stage small cell carcinoma of the prostate after PR to chemotherapy?
Generally, no, unless there is a compelling case for local control to avoid symptoms.I suppose the rationale in favor would be extrapolating from thoracic RT for extensive stage SCLC, but that is probably a stretch. The dose in that argument would be relatively low (30 Gy / 10 fractions, as in CREST...
How do you approach treatment of an IDH wild-type low-grade astrocytoma in an elderly patient?
Inherent in this good question are really two separate issues: 1) how to approach IDH-wt LGG and 2) how to treat glioma in the elderly (and/or frail).The first issue is addressed by the recent cIMPACT-NOW update #3 which states that in the presence of an IDH-wt gr 2-3 glioma, the presence of one of ...
What dose-fractionation would you utilize to palliate a symptomatic distal rectal cancer in an inoperable elderly gentleman with previous prostate bed radiation therapy 30 years prior?
First, I think we should all remember that the incidence of rectal cancer is about doubled after prostate RT. That would generally not influence my decisions about using RT for prostate cancer, but we should keep this in mind (and inform the patient). The decision about palliative RT is heavily depe...