Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are the indications for adjuvant radiation for a resected intracapsular carcinoma ex pleomorphic adenoma of the parotid?
It is unclear to me how the "intracapsular" component would change management since I am not familiar with this entity. However, carcinoma ex pleomorphic adenoma is a high grade cancer and merits PORT. If neck is pN0 after an adequate dissection, theoretically does not need treatment. In treating ...
How exactly would you utilize ADT via leuprolide or bicalutamide with salvage RT post prostatectomy with PSA >0.5?
The dilemma on the need for hormonal therapy in the salvage radiation setting after radical prostatectomy is a major one in current clinical practice, driven by the modest survival benefits seen in the RTOG 9601 trial with 2 years of bicalutamide (Shipley et al., PMID 28146658), but also follow up s...
For lung SBRT, do you constrain dose to small bronchioles/small airways?
Hi MedNet,I got this question via email as well and answered it there, but for the broader community, I’ll answer here too.I do not. There are many ways to think about problems like these and a lot depends on the patient’s characteristics. There’s a convincing amount of anecdotal data that ultra cen...
Are there any breast ca patients for whom you would offer PMRT if they were cN0 and ypN0?
There are a few patients, I will still offer RT for if they are cN0 and ypN0. cT4 disease T3N0- will consider for young age, triple negative I don't routinely offer to cT1-2N0 patients unless positive margins.
How do you counsel patients/families whose goals of care are clearly aligned with a comfort-focused, end-of-life approach, but who are hesitant to formally enroll in hospice?
Hospice sounds like a 4-letter word to a lot of families! I find it important to distinguish the philosophy of comfort care vs. the benefit package associated with enrolling in hospice. Some people are able to be provided end-of-life comfort care without electing the hospice benefit, and that is fin...
How do you classify extensive LVSI in endometrial cancer?
There are various definitions floating around but one with an outcome in the absence of nodal dissection is from PORTEC group showing the significance of 4 or more vessels involved.Peters et al., PMDI 34261899 Our data questions the true significance of substantial LVSI > 1 vessel as used in previou...
For a patient who previously underwent PBI and then developed a second ipsilateral primary, would you offer repeat PBI?
If this is a younger patient, I would confirm that they have negative genetic testing before considering re-irradiation, and, in any case, ideally, the management options would be discussed with the patient and surgeon prior to offering breast conservation surgery. Considerations would be the locati...
Is it appropriate to use bolus with hypofractionated PMRT?
Bolus is being used less and less. Most people would only use if T4 disease or if they had a positive margin or some other high-risk factor for skin/superficial recurrence. The indication for bolus would not change based on fractionation. If there was an indication to bolus with conventional, then y...
Would you consider APBI in a patient who meets all criteria but has high-risk genomic testing and is not receiving chemotherapy?
I would proceed with APBI 30 in 5 as it has a boost dose built in to account for a high genomic score.
Should other treatment options be considered for MALT lymphoma if the lacrimal gland will be included in the radiation field in a patient with Sjögren's disease?
The orbit is the second most common site of origin for extranodal marginal zone lymphoma (MZL). Involved orbital structures include the bulbar and/or palpebral conjunctiva, lacrimal gland, and periorbital soft tissues. Patients with Sjögren’s syndrome (SS) are at increased risk for developing extran...