Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose would you consider for a patient who received 59.4 Gy 18 years ago for a glioma of the right frontal lobe who is now S/P gross total resection for a high-grade glioma in the same area?
Given that the patient was treated 18 years ago and has undergone GTR, I would be more inclined to treat to the full dose using standard fractionation; 54-59.4 Gy in 30-33 fractions (depending on molecular features). I would treat with concurrent bevacizumab in addition to any other systemic therapy...
Is it acceptable to give hypofractionated breast radiation in a patient who is being treated for rheumatoid arthritis with Actemra, methotrexate and leucovorin?
I don’t think fractionation makes a difference to toxicity as long as dose homogeneity is met.
How do you reconcile the differences between 2022 ABS APBI recommendations and 2023 ASTRO APBI recommendations?
Some of the differences arise not due to negative data but rather from insufficient data or representation in clinical trials. For instance, lobular histology, which in the MRI era, has a high negative predictive value for multifocality/centricity.
What ENI/lymph node stations would you treat for a locally advanced SCC of the thumb?
Axilla is most likely, and then epitrochlear fossa.
In oral cavity cancers, how does WPOI (worse pattern of invasion) influence your decision to offer adjuvant therapy?
It doesn’t.
How do you advise a patient on ozone therapy?
I’d advise against it.
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).