Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for radiation therapy after chemotherapy for localized anaplastic large cell lymphoma?
Hard to answer this question as posed. ALCL when localized is primarily confined to skin. Treatment of choice in this circumstance is RT alone, generally 40 gy in conventional fractions. ALCL not primarily in the skin is a systemic disease best rx'd with chemo, rarely localized. For the latter, I wo...
What is the best management of a lacrimal gland MALToma?
Ocular MALT can occur in the conjunctiva, lacrimal gland or retroorbital tissue. Although chlamydia can cause this, treatment with antibiotics without documenting infection has not been reported to have a significant response rate. Even in patients who test positive for DNA, I have seen mixed respon...
Are there situations in which hypofractionated breast RT is acceptable after neoadjuvant chemotherapy and lumpectomy?
In my practice, I routinely offer hypofractionated whole breast radiation plus a boost (40 Gy/15 fractions plus 10-14 Gy in 5-7 fractions, as per START B) to any patient 40 and older who has received neoadjuvant chemotherapy and lumpectomy, provided my target is the breast only or breast plus low ax...
Would you give breast radiotherapy to a patient with a history of bilateral retinoblastoma?
I would certainly be concerned about it, especially if patient has been tested and is positive for hereditary RB. The risk of a secondary malignancy in the RT field would increase many fold, especially bone or soft tissue sarcoma. Although I have not treated anybody, I may consider the patient for p...
Is post-mastectomy RT recommended for patients who have a local failure after partial breast irradiation?
In general if a mastectomy was performed for an inbreast local relapse, whether the patient recieved partial or whole breast previously, or even no radiation, I would not offer PMRT unless there were specific risk factors indicating a need such as a diffuse relapase, dermal invasion, extensive lymph...
Would you use SBRT to treat a >5cm NSCLC with chest wall invasion in a medically inoperable patient?
This is a very relevant and interesting question as the patterns of practice and indications for lung SBRT continue to evolve. It also fits in nicely with two recent retrospective reviews we conducted at the Cleveland Clinic using our 10-year old lung SBRT data registry. Addressing the first compone...
Is there an age cutoff you use to determine when you will offer standard vs hypofractionated breast radiation in early stage breast cancer?
About 20% of patients in both START A and START B were under the age of 50, and these were huge trials. As such, I don't see a compelling reason not to treat younger women with hypofractionation. To put it another way, I don't think we have good reason to believe that schedules that are designed to ...
Would you offer adjuvant radiotherapy to a small low grade T1 adenoid cystic carcinoma of the minor salivary gland that was completely resected?
I can think of one ACC patient I have not irradiated postop in over 35 years. This would be the second. 3mm? Really? 3cm I would irradiate.
Should the incorporation of thoracic RT be standard in patients with extensive stage small cell lung cancer?
The jury is really still out on the issue of whether or not to add thoracic radiation therapy to prophylactic cranial irradiation (PCI) in patients with extensive-stage small cell lung cancer. The published data cited above, Slotman et al. in Lancet last Fall 2014, indicate that there may be an over...
Are there ever indications to include the inguinal nodes in the RT treatment field in a testicular seminoma?
I would not consider any situation as a definitive indication to treat inguinal region prophylactically for seminoma, unless the inguinals are involved.