Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you optimize definitive external beam pelvic radiation in a patient with cervical cancer that is unable to fill her bladder due to bilateral percutaneous nephrostomy tubes?
It’s better to treat with an empty bladder as it is reproducible for this scenario and reduces the uncertainty of the uterus and cervix position. The total dose is only 45 Gy in 25 fractions so within the limit of organ tolerance.
In a patient with otherwise favorable DCIS and a focally positive margin who refuses reexcision, is APBI an appropriate treatment option?
Typically speaking, with positive margin, we always discuss re-excision (if possible and if the surgeon thinks it’s a true positive margin). If the patient refuses, with positive margin, I would offer her whole breast and a boost, I would not favor APBI.
How would you manage worsening severe macroglossia affecting function in a patient after definitive chemoradiation in the subacute setting for p16+ SCC of the base of tongue?
I don’t think that I’ve ever seen it in the absence of a surgical procedure such as a bilateral neck dissection causing edema?
Would you do APBI for encapsulated papillary carcinoma with negative margins and no surgical axillary assessment?
They, for the most part, behave like low-grade DCIS and would be fine with either (whole breast or APBI).
Would you consider adjuvant radiation for a patient with recurrent pelvic node melanoma s/p immunotherapy and pelvic lymph node dissection with complete pathological response (only necrotic tissue; no viable melanoma)?
At this point, no. These patients seem to have a low risk of recurrence if they experience pathologic complete response following neoadjuvant immunotherapy.
Would you ever start adjuvant pelvic radiation with a drain in place?
I wait for the drain to be removed as it’s in the target location.
Do you offer APBI to patients with close margins?
If otherwise suitable for APBI, we follow no tumor at ink as negative margin.
Do distant lymph nodes from metastatic prostate cancer (retroperitoneal and SCV) count as oligometastatic disease?
I would treat more like oligopersistence/progression and limit treatment to visible disease only and not the chain.
How would you address squamous cell carcinoma in situ focally present at the bronchial margin after lobectomy?
Rare event so not great data to guide decision-making here. Technically, this is an R1 resection but a positive resection margin due to residual microscopic invasive disease is a distinct entity from a positive margin due to CIS. There is a nice review from JTO that covers this topic (Vallières et a...
For a pedunculated rectal polyp found to be adenocarcinoma after endoscopic removal, with PNI as the only adverse feature, would you recommend additional treatment such as surgery or chemoradiation?
Yes