Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Is prior whole brain radiation and/or spinal radiation within last 6 months a contraindication for intrathecal methotrexate treatment in with leptomeningeal disease?
We treated a few patients with leptomeningeal disease with palliative RT in conjunction with IT MTX in our institution, with RT delivered safely within 1 week of IT MTX without any apparent increase of clinically significant toxicities. There are no high-quality data to suggest that palliative RT is...
What is the minimum amount of time you should wait between a TURP and the start of definitive prostate radiation therapy?
I am not aware of any solid data on which to base an answer to this question, however, it is a problem that still occasionally arises. A recent summary of the data pertaining to the risk of late effects from prostate radiation after TURP, published in the American Journal of Clinical Oncology in Jun...
What head and neck subsites would you treat for a SCC of multiple ipsilateral neck nodes (clinical ECE, no contralateral nodes) with unknown primary origin site despite full workup?
Oropharynx, bilateral neck, ipsilateral RP nodes, and nasopharynx. You could omit the NPX but you’re up there anyway to treat the RPs.
What is an appropriate target volume for a chordoma or chondrosarcoma after a gross total resection?
The CTV for postop chordoma or chondrosarcoma after gross total resection should include the entire surgical resection cavity as well as incision and drain sites with a 1 cm margin for the initial 50.4 Gy. Then cone down off the incision and drain site and cover the high risk margins based on the or...
When treating APBI with the Florence regimen, are you using daily or every other day fractionation?
qD When I started doing this at the beginning of the pandemic, I reached out to the authors of Livi study and they said that despite the study, they were treating every day without issue. Then, they wrote up their series of patients treated qD. It was effective and safe.
Are there any special considerations when giving breast radiation to a patient with Sjogren's syndrome?
I have not adjusted my dose/fractionation or approach for patients with Sjogrens. I have also offered both WBI and PBI.
Do you offer patients BID treatment days during holiday weeks with only 3 business days?
My old practice would treat curative patients on the Sunday before Thanksgiving to allow for the longer weekend (Th - Sun), thereby getting patients 4 treatments for the week. There is the consideration of a 4 day break, but it's radiobiologic theoretical concerns, and I'm unsure that anyone would b...
What is your preferred CSI dose/fractionation for leptomeningeal disseminated low-grade glioma?
When treating leptomeningeal dissemination (LMD) of low-grade glioma (LGG) with craniospinal irradiation (CSI), radiation doses vary depending on the patient's age and clinical situation. While definitive dosing is still being investigated, established ranges from clinical practice and studies provi...
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...