Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
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...