Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What evidence supports the use of high tangents for pN1mic breast cancer?
This is a great question. To add to the excellent answers from @Dr. First Last and @Dr. First Last, here are some of my thoughts on this topic:At the time of MA.20, the size of nodal metastasis was not routinely measured so it is unclear what percent of patients in MA.20, if any, had micrometastases...
Do you prescribe silvadene cream for patients with a sulfa allergy?
No. I will consider hydrogel wound dressings in those situations
What is your preferred method for adding bolus, at CT sim or virtual bolus?
Absolutely, should always apply at sim. Gives you an opportunity to work out the appropriate positioning of the patient to optimize bolus conformality and to select the appropriate bolus type (frequently Superflab but often you don’t know until you get the patient on the sim table whether custom mol...
Is ultrahypofractionation appropriate for a B51 candidate receiving breast-only radiation?
"I believe in the data of biologic equivalence, and I just treated patient X with ultrahypofractionation (UHFRT)...but I can't treat patient Y (who looks extremely similar to patient X, with a few idiosyncrasies) with UHFRT...because '"reasons"' ...*scratches chin* Hard as it may be to believe, ther...
Is ENI necessary for postoperative treatment of clinically N0 adenoid cystic carcinoma of the head and neck?
Adenoid cystic carcinoma (ACC) is an uncommon malignancy of the head and neck characterized by an intermediate growth rate and a propensity for local recurrence, perineural tumor spread, and distant metastasis. Historically thought to be radioresistant, patients were treated with surgery alone until...
Is it ever appropriate to omit temozolomide in unmethylated glioblastoma?
Perhaps a different perspective on this question would be which unmethylated patients would you be willing to not treat with up-front temozolomide? The genesis of the question and conundrum comes from the modest benefit described in the above-mentioned trials for this subgroup. As Hegi herself descr...
In patients with nasopharyngeal SCC that have an excellent response to induction chemo, do you alter your chemo-RT dose/volumes in any way?
I agree with Dr. @Dr. First Last. I do not change my volumes based on response to induction chemotherapy. It may be difficult to outline the nodal volume if there is complete response to chemo but I have not really encountered that scenario so far. I use the initial PET and diagnostic CT scans fused...
What's your follow-up protocol for a near complete response (nCR) in rectal patients considering non-operative management (NOM)?
This is a question that comes up in our colorectal tumor board routinely. For patients with a near-complete response after the completion of TNT, we recommend repeating an MRI of the rectum and endoscopic exam ~8 weeks later. If there is still a lack of complete response, our formal recommendation i...
How do you manage oxaliplatin-induced splenomegaly?
Oxaliplatin can lead to sinusoidal obstructive syndrome (SOS), which will result in portal hypertension. Splenomegaly is one of the portal hypertension signs.The SOS is correlated with cumulative oxaliplatin dose, and cumulative dose >1000 mg/m2 is considered a potential threshold (Overman et al., P...
What is the role of adjuvant RT for metastatic RCC to the thyroid resected with high-risk features?
There is no established role for adjuvant radiotherapy after thyroidectomy for RCC metastases, even with high-risk features. Most published evidence consists of small retrospective series or case reports. When RT is used, it’s generally for palliation. That said, selected high-risk cases (positive m...