Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose of reirradiation would you consider for locally recurrent breast cancer after mastectomy, excised with positive margins?
These are complex cases and lots of factors to consider when planning adjuvant therapy (age and comorbidities, tumor biology, other pathologic features like LVI, reason for the positive margin, plans for systemic therapy, presence of reconstruction, the volume of prior radiation, extent of clinicall...
Would you consider repeat lumpectomy and external beam partial breast reirradiation for in-breast recurrent cancers?
Patients experiencing a localized recurrence in a breast previously treated with lumpectomy and whole breast radiation are appropriately offered salvage mastectomy with or without reconstruction as an acceptable standard. However, many patients wish to have options that preserve the breast. Repeat l...
Do you offer palliative whole liver radiation for patients with diffuse liver metastases?
Whole liver radiation is a very good palliative treatment for diffuse hepatic metastases causing pain or severe nausea/vomiting. I treat the whole liver plus a 1 cm margin to 7-8 Gy/1 fraction per the Phase II trial from Princess Margaret Hospital (Soliman et al., PMID 24062394). In this trial of 41...
How should dose homogeneity across bone be handled in pediatric patients?
The radiation-associated bone damage can be affected by many factors, including total radiation dose, fractionation schedule, treatment volume, age of the child, symmetry of the delivered dose over vertebrae, developmental status of the irradiated growth plates, treatments such as chemotherapy or su...
Do you treat elective nodes in unresectable pancreas when treating with 15fx?
No, the standard has been to include only grossly enlarged node, so for now we do not include elective nodal irradiation. We will re-evaluate this practice when we have more data and are better able to assess the pattern of disease progression. We are treating over 100 cases a year uniformly, so thi...
When would you offer post-op radiation for the treatment of sebaceous carcinoma of the eyelid?
I think of them as poorly differentiated and it’s a location where margins are likely close so always.
How do you manage a head and neck cancer patient with the presence of high grade dysplasia at a margin?
This is an excellent question. According to some pathological literature, a margin positive for in situ carcinoma or high grade dysplasia has a similar recurrence risk as a frankly positive margin with invasive disease. NCCN guidelines define carcinoma in situ or invasive disease as a "positive marg...
In clearly resectable pancreatic adenocarcinoma with no arterial or venous involvement, is there a role for neoadjuvant chemotherapy?
There is currently equipoise regarding this question, and the Alliance A021806, a phase III trial evaluating perioperative versus adjuvant therapy for resectable pancreatic cancer, clinical trial will address it. There is a role in certain subsets of patients without clear vascular involvement regar...
Should special precautions be taken patients with Ehlers-Danlos syndrome receiving radiation therapy?
Not all EDS is the same. Most commonly, an EDS patient these days is a clinically diagnosed patient with hypermobile joints, possibly stretchy skin, and possibly chronic pain syndrome. That is a very different picture from vascular EDS with a COL3A1 mutation, which is rare and would have the extreme...
After wide local excision of a DecisionDx-SCC Class 2A cutaneous SCC of the posterior inferior scalp, would you irradiate nodal basins?
Yes, if I were going to irradiate the operative bed. I do not know prospective data on the use of adjuvant radiotherapy for nodal basins only in squamous or basal cell skin cancers, Cf. Porceddu et al., PMID 25993217, where a minority (5%) of patients are at risk for relapse, typically locally or re...