Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should chemoradiotherapy to primary and neck be offered to patients with Stage IVC nasopharyngeal carcinoma with limited osseous disease?
Yes. Please refer to the recent small phase III randomized trial: You et al., PMID 32701129. Anecdotally, I have treated an Asian patient with EBV-associated NPC who had a single sternal met at presentation with definitive chemoxrt (no induction) who is is ~7 years post treatment and is NED.
If small cell carcinoma was found in an axillary lymph node with an unknown primary, would you recommend axillary lymph node dissection prior to chemoradiation?
Just to be clear, is this a patient with lung cancer? I know this is posted in the thoracic section, and has been responded to by a thoracic specialist, but usually “small cell carcinoma” in axillary lymph nodes without disease (especially in the thorax) elsewhere is Merkel cell carcinoma (cutaneous...
Do you consider adding a brachytherapy boost to IMRT in patients with cT3b and/or cN1 prostate cancer?
For T3b disease we do consider a brachy boost. We look at MRI imaging and based on extent of involvement which usually is to proximal part, and if it appears we can implant that area to full dose, we consider a brachy boost.
How would you treat a pediatric embryonal rhabdomyosarcoma of the kidney with preoperative rupture s/p nephrectomy and getting VAC/VI chemotherapy?
This is an uncommon clinical presentation. If there was diffuse abdominal spill, then whole abdominal radiotherapy would be indicated. Though recent COG study guidelines specify 24 Gy whole abdomen radiotherapy dose, that may not be adequate for microscopic tumor. In other tumors (ie, diffuse small ...
Do you recommend elective lymph node irradiation for a basal cell carcinoma of the skin that is deeply invading muscle?
The decision to treat lymphatics would depend upon the level of differentiation of the basal cell carcinoma. It is not unusual for a large [4 cm] lesion to deeply invade and destroy surrounding normal tissue. This does not necessarily mean that it will have spread into the lymphatics. Over the past ...
How would you advise your patient about starting adjuvant breast radiation who has a planned vacation?
I would be reluctant to delay initiation of RT for that long in patients who had neoadjuvant chemo and lumpectomy. No prospective study but retrospective data shows inferior outcome when RT is delayed beyond 8 weeks or so for patients who have NACT.
What techniques do you use to minimize gas artifacts on cone beam CT when treating upper abdominal lesions?
Gas and motion artifacts are significant causes of poor image quality for imaging studies that have a long acquisition time such as cone beam CT. The problem areas are in the upper abdomen where the impact of respiratory motion is greatest. Organ motion can be controlled in most patients, but the pr...
How do you treat recurrent tracheal carcinoma?
Endotracheal HDR can work, though will be hottest on the luminal surface and have limited penetration. Another strategy to consider was just published: "Percutaneous CT-fluoroscopic-guided radioisotope seed placement for the management of adenoid cystic carcinoma of the trachea."
Should NSCLC with positive cervical nodes be managed with definitive chemoradiation?
The AJCC staging system in conjunction with the IASLC lymph node map is quite clear on this issue. Cervical lymph nodes are non-regional and in the TNM classification are noted as M1b or stage IV. From a practical standpoint though, one should consider the number and location of the lymph nodes in q...
Would you consider post-mastectomy radiation in patient with a triple negative tumor pT2N0?
In borderline cases, I look at some of the retrospective data showing higher recurrence rates in patients with close margins, premenopausal status, higher grade and T2 tumors.In the specific case in the OP, I would discuss the data from the Chinese randomized trial (green journal 2011) showing an OS...