Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you consider consolidation chest radiation in a patient with stage IV non-small cell carcinoma of the lung who has had good response to systemic therapy?
It's a really great question, and it comes up a lot in our tumor boards and general practice. There are a couple of paradigms that I use to help me think through when and how to do it. I would say the data here for the use of RT is mixed, and either gives you freedom to do a variety of things or giv...
How would you manage a pT2N1a invasive ductal carcinoma s/p lumpectomy and sentinel lymph node biopsy with ECE, and two mildly avid axillary lymph nodes on post-op PET/CT?
We often see mildly active lymph nodes on post-op PET/CT scans, so one important initial question is how long after the surgery the PET/CT was performed. Another question would be how many total lymph nodes were removed at the sentinel biopsy. If the scan was done ~6 weeks post-op and the patient ha...
How do you approach postoperative radiation therapy in a patient with head and neck cancer who has high risk of recurrence in the setting of active epidermolysis bullosa?
Epidermolysis bullosa is a rare genetic entity characterized by collagen mutations affecting the attachment of epithelial cells to the basement membrane of the skin and mucosa, manifesting in blistering and non-healing skin wounds and mucosal strictures in the GI tract. There is a risk of non-healin...
How, if at all, does your practice differ between male and female breast cancer patients with respect to the use of bolus?
Not sure if I understand the question. The skin is not the target here; it's the chest wall. Contour it and cover it. Without an indication for increasing skin dose (T4 disease, etc.), I'm not sure of the value of bolus in either men or women.
In what situations would you recommend adjuvant radiation therapy for patients with locally advanced and/or recurrent basal cell carcinoma that receive vismodegib followed by surgery?
Adjuvant radiation therapy should be considered for locally advanced basal cell carcinomas when surgical margins are positive, or when there is perineural invasion, particularly in high-risk anatomical locations such as the face. This recommendation is endorsed by both the NCCN and the American Acad...
How would you approach the radiation treatment of multiple recurrent lentigo maligna on the sole of the foot in an active patient not desiring further surgery?
While surgery remains the gold standard in the management of lentigo maligna (LM), radiotherapy has been used for decades as an alternative, particularly in those patients with surgical comorbidities or where surgery may result in poor functional or cosmetic outcomes. Additionally, radiotherapy is o...
Would you give lung SBRT to a patient with bullous pemphigoid on the chest and torso?
If this patient has a clinically relevant lung cancer (which, by the clinical description, it sounds like it is felt they do) then I would feel comfortable treating them with SBRT. The very focal nature of SBRT makes this a very different scenario than large-field radiation. There is minimal data ov...
Do you offer SBRT Liver for patients with low platelets?
The highest predictor for the development of HCC is cirrhosis, and with cirrhosis invariably comes portal HTN and low platelets. Almost all of our primary HCC patients have some degree of thrombocytopenia, many below 100,000. As such, we have treated them all without difficulty or complication. We w...
Does pre-chemotherapy extent of nodal involvement impact your decision to offer adjuvant radiation in cN1, ypN0 triple-negative breast cancer?
There are few data on this subject. The group at the Netherlands Cancer Institute in Amsterdam created what they called the "MARI" approach for such patients (Koolen et al., PMID 28524246). In brief, they performed an axillary ultrasound and marked the largest suspicious node with a radioactive seed...
How do you sequence chemotherapy with radiotherapy for advanced endometrial cancer?
Unfortunately, we don’t even know for sure if we need RT for stage III disease.GOG 258 showed early concurrent chemo RT is no better than chemotherapy alone (delaying chemo increased distant mets, which probably negated locoregional control benefit of RT). For this reason, chemotherapy has become st...