Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do young, early-stage breast cancer patients with pCR to chemoimmunotherapy still benefit from PMRT?
As far as I am aware, it is not part of the usual practice to offer PMRT in the setting of T2N0 TN breast cancer. Though I think it may be considered as an "out of the box" recommendation in the setting of multiple high-risk features (larger T2 size, poor response to neo-adjuvant tx, LVI, young age,...
How do you manage the thickened secretions secondary to xerostomia during head and neck radiation?
I find that the management of acute effects of RT for H&N treatment is somewhat of a dark art. What works for one patient may not work for another. The thickened secretions are from acute irritation of the salivary glands and not so much from "xerostomia" during the acute phase of RT. For thickened ...
How would you approach adjuvant therapy for a fully resected vulvar carcinoma with a single positive lymph node?
There is not a simple answer to this question. In most cases, omitting adjuvant therapy is appropriate, but in certain cases, adjuvant radiation therapy + chemotherapy is advised, even in the presence of only a single positive lymph node. It has been over 30 years since Homesley and co-workers’ 1986...
How would you approach a T1N1 NSCLC with a small peripheral primary tumor and single hilar node in a patient not fit for concurrent chemo or surgery?
If the patient were not a candidate for surgery or chemotherapy, then I would favor hypofractionated radiotherapy to 60 Gy in 15 fractions to both the primary and the hilar lymph node based on UTSW phase I data. If the patient may be a candidate for immunotherapy, then I would strongly consider enro...
For a young patient with high grade pT1N0 medially located breast cancer, under what circumstances would you include the IMN in your treatment fields?
For patients treated with upfront surgery who are T1N0, I personally do not radiate the lymph nodes, even in young patients with high grade lesions. An exception could be in patients with extensive LVI where the likelihood of nodal involvement is higher. For patients with initially more advanced dis...
Would you treat a pleomorphic sarcoma of the pelvis post-operatively?
This is a difficult question to answer directly because it depends very much on the precise anatomic location of the tumor and the extent of surgery. A pleomorphic sarcoma in the pelvis could represent: Lower retroperitoneal pleomorphic sarcoma (which can include the pelvis) Arising from the pelvic...
What is your preferred dose/fractionation for WHO grade 1 meningiomas?
This question includes many offshoots which impact optimal dose and fractionation, such as target volume, anatomic locale, presence of edema, surgery and its extent, and recurrence status. Patients with small (<10 cc, perhaps even <7.5 cc) supposed (unresected) WHO grade 1 meningioma do very well wi...
How do you manage a cervical cancer patient on anti-coagulation for pulmonary embolism requiring interstitial brachytherapy boost?
Have done with IVC filter and switch to heparin days prior to the procedure so that can hold anti coagulant for the procedure and epidural placement for analgesia.
Would a finding of isolated tumor cells on SNB impact your decision to offer omission of radiation in a patient with breast cancer who is otherwise a candidate?
ITCs raise our eyebrows, for sure, but are not technically a reason to treat. As this was not recorded in the CALGB study and the majority of patients did not have any axillary evaluation, it is quite likely a portion of patients had ITCs, and yet still did not have excessive rates of recurrence.Tha...
Would you recommend PMRT for T2N0(i+) breast cancer?
In this situation, I do not normally offer PMRT as long as margins are negative. There are some that would consider in this scenario if triple negative but I don’t usually.