Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat anal adenocarcinoma?
First of all you have to define what you are dealing with. Adenocarcinoma of the anal canal is a rare condition arising from anal glandular tissue. There is no IHC marker or definitive histologic finding that can differentiate it from rectal cancer with extension into the anal canal. The suggestive ...
What are the indications for postoperative radiation for extramammary Paget's disease?
This is a very interesting rare disease, and a great question. We have had a relatively high volume of these cases come through our dermatology department. First of all, it must be invasive extramammary Paget's disease to even consider radiation. Second of all, the workup must include screening for ...
Would you consider partial breast irradiation in patients who otherwise meet PBI guidelines who have a pathogenic variant of CHEK2 or other moderate penetrance gene?
I would favor whole-breast RT. Although we don’t have data on moderate penetrance genes, in BRCA mutation even whole breast prophylaxis data suggests less risk of a second new primary in these patients. Evron et al., PMID 30475942
How would you treat a patient who has a large DCIS status post mastectomy and implant with extensive positive margins?
I would treat with PMRT to 50 Gy in 25 fractions followed by boost as it looks like the patient has a significant margin positive.Based on the location of implant (pre pectoral or retro pectoral) contouring and at risk volume is different. The consensus guidelines addresses this: https://www.ncbi.nl...
Would you dose escalate neoadjuvant radiotherapy for T3 and/or N+ rectal cancer in patients who are unwilling or unable to get chemotherapy?
If a patient with rectal cancer is not able and/or unwilling to receive concurrent radio-sensitizing chemotherapy with pre-operative intent radiotherapy, I would recommend the use of short-course radiotherapy with 25 Gy in 5 fractions.Multiple trials, including TTROG 01.04 and Polish 1 Bujko et al.,...
How are you clinically incorporating the data presented from RT Charm at ASTRO 2024?
This is an appropriate question with the presentation of RT CHARM at ASTRO a few weeks ago. We have been utilizing hypofractionated NON-reconstruction PMRT and regional nodal breast RT for years in my practice given our large geographic catchment area. As a general rule, I feel it's always best prac...
Would you recommend MRI post surgery and pre-irradiation for patients with extensive DCIS and close margins and how would it impact your management?
MRI post-op may be hard to interpret. Favor mammogram especially if had microcalcifications pre-surgery, it makes sure they are all removed.
Does location of an non-spinal osseous metastasis affect your SBRT dosing?
Just a few thoughts: Location is an important consideration for SBRT dosing because normal tissue tolerances vary by organ/location. Three complications that I worry about are the risk of bone fracture, neuropathy and myositis when treating non spinal osseous mets with SBRT, especially in the settin...
For AYA patients with early-stage Hodgkin's lymphoma being treated with ABVD, how many cycles of chemotherapy do you administer, and when can radiation be avoided?
It depends - favorable/unfavorable, distribution of disease, co-morbidities, gender, family history, etc. I don't treat pediatric patients, so the comment below applies strictly to young adults.If a patient has early-stage, favorable HL per GHSG criteria (no risk factors), then 2 cycles of ABVD + 20...
For patients receiving TNT for locally advanced rectal cancer who have received chemotherapy prior to chemoradiotherapy, do you treat the pre or post-chemotherapy volume for the boost, especially in patients who have had a near complete response?
I base my boost volume upon the pre-chemotherapy extent of gross disease. Times I have selectively deviated from this are almost exclusively related to unfavorable normal tissue anatomy (i.e., significant volume small bowel deep in the pelvis) such that covering the initial extent in the boost volum...