Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat recurrent unresectable skin nodules on the chest wall after mastectomy and axillary lymph node dissection?
I would consider systemic treatment first based on phenotype to see if that could make it resectable.I would favor that, as surgery followed by RT would offer a better outcome.As for as RT field is concerned, I would treat chest wall and regional nodal region routinely for the recurrent disease in c...
What is your superior field (or CTV) border when treating para-aortic lymph nodes with extended field radiation therapy for endometrial cancer in the post-operative setting?
For prophylactic pa nodal region treatmentIi treat up to the renal vessels and dont use any bony landmark.If there is a node up to the renal vessels that is involved, then I consider extending 2 to 3 cm above the involved node including and contouring retrcrural region.See below reference for above ...
How would you treat the axilla if a breast cancer patient had cN1 disease in the axilla but after neoadjuvant chemo the SLNB revealed no positive nodes and the clip placed in the axilla was not found?
I would image to make sure clip and node not in situ if not there based higher false negative when less than3 nodes are retrieved and clip not found would treat regional node comprehensively
How would you approach treatment of an early-stage lung cancer adjacent to a prior lung cancer previously treated with SBRT?
Regarding treatment of metachronous lesions in close physical proximity with repeat SBRT, I would employ some of the same concepts that I would be using if I were retreating a local failure after SBRT with repeat SBRT. In other words, I would consider location and the cumulative dose to the relevant...
Is antiandrogen monotherapy a reasonable option for a patient with high-risk disease getting IMRT (+/- BT boost) who refuses GNRH modulators?
I do use anti-androgen monotherapy as a compromise for patients who refuse LHRH agonists. Many patients walk out the door when LHRH agonists are mentioned. The PSA nadir is not as low with biclutamide as with LHRH agonists. There is experience with biclutamide at 150 mg both in non randomized report...
In what situation would you cover the scar of a temporary tracheostomy post-operatively for oral cavity cancer?
Oral Cavity cancer is a very aggressive disease, in particular, oral tongue. I would treat everywhere surgically violated. Nancy Lee
For metastatic and bulky locally recurrent carcinosarcoma, what palliative dose would you deliver to the pelvis for symptomatic control?
Based on performance status, I have done 3.7 Gy BID for 4 fractions (which can be repeated in the future if need be) or 30 Gy in 10 fractions with good palliation.
Under what circumstances would you recommend hypofractionated radiation for bladder cancer?
In the BC2001 study (James N, NEJM 366:1477, 2012) that showed a benefit to chemoradiotherapy over radiotherapy alone, two fractionation schemes were allowed: 64 Gy in 32 fractions of 2 Gy or 55 Gy in 20 fractions of 2.75 Gy. Of the 360 patients in the trial, 40% had the shorter, 4 week fractionatio...
Would you boost a positive margin (R1 resection or R2 resection) in a GEJ esophageal carcinoma that completed neoadjuvant chemoradiation?
Theoretically this might be feasible if it is a radial margin and not a mucosal margin because the irradiated mucosal structures would have been resected. There is no evidence-based answer to this question and I'm sure there are people that feel that further radiation is indicated. Not all patients ...
What is your approach to young healthy women with locally advanced breast cancer and biopsy-proven low cervical lymph nodes?
At this point, we treat them with definitive intent as most often these low cervical nodes are level 4 or adjoining level 5 node which by definition are supraclavicular nodes (often radiologists call them as cervical nodes but one needs to see images to confirm location). A subset of patients with t...