Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach a patient with vitreoretinal lymphoma without CNS or systemic involvement?
The optimal treatment approach for primary intraocular lymphoma is debated. This is a rare disease with only small retrospective series guiding therapy. There is no clear superior treatment approach in the literature. In clinical practice, younger patients are often treated initially with high-dose ...
Would you recommend adjuvant radiation therapy to the locoregional lymph node basins for Merkel cell carcinoma (MCC) s/p WLE with negative margins and isolated tumor cells in 1 of 3 right inguinal sentinel lymph nodes?
Yes, this is not an easy disease to cure in the node-positive setting. So, the question can be framed: do isolated tumor cells constitute a benign finding, frank malignancy, or a space in between? I don't have an answer to that, and perhaps given the rarity of the entity, that answer will remain rec...
How is your approach to a patient referred for radiotherapy for keloids with a history of Beals syndrome?
Although of theoretical concern, I am not aware of any contraindication to RT (treatment philosophy similar to Ehlers-Danlos syndrome).
What radiation dose and margins would you recommend for treatment of a progressive cerebellar glioma with BCOR/BCOR1 fusion after initial subtotal resection with residual disease adjacent to the posterior brainstem?
BCOR fusion glioma is a rare type of brain tumor, often seen in children and young adults, characterized by gene fusions involving the BCOR (BCL6 corepressor) gene with partners like EP300 or CREBBP, leading to unique molecular and histological features, presenting as high-grade neuroepithelial tumo...
How do you conduct follow-up on patients with brain mets who have undergone GammaTile placement?
For patients with high-grade gliomas, they get an immediate post-implant CT and MRI for dose calculation, then I schedule serial follow up CE-MRI every 9-10 weeks for at least a year; if stable at the one-year mark, I "graduate" the patient to get MRIs every 12 weeks for the second year of follow-up...
How would you manage a rare presentation of an older adult after gross total resection of an "infant-type hemispheric glioma" of the left frontal lobe, IDH1 negative and negative for MYB fusions?
Infant-type hemispheric gliomas (IHGs) are rare high-grade astrocytic tumors characterized by giant size and abundant vascularity, often with regions of cystic transformation. They are aggressive brain tumors that occur during early infancy, usually between 0 and 12 months of age. They are often ver...
For mCRPC patients who are eligible for both, how do you decide between Enzalutamide+Rad223 (EORTC 1333/PEACE-3) or Enzalutamide+Lu-PSMA-617 (ENZA-p)?
While both these studies addressed interesting questions, both enrolled patients who were ARPI-naive. We are in an era where ADT intensification is the standard of care, and hopefully, we will see an even smaller number of folks with mCRPC who would look like the patients enrolled in both these stud...
Does the presence of an ATM mutation impact your fractionation regimen for a woman with breast cancer?
ATM mutation is not a contraindication for RT. Techniques should be used to reduce scatter dose to contralateral breast. This is very good review on the topic.https://www.ncbi.nlm.nih.gov/pubmed/31381960
Is it acceptable to treat newly diagnosed small cell lung cancer with limited brain metastasis with upfront SRS?
First, to be clear, there's not good evidence regarding the role of radiosurgery in small cell patients who have not had WBRT or PCI. In patients without brain metastases, there's a clearly defined and clinically significant survival benefit, which seems to result from both control of existing metas...
What dose and treatment area of radiation should be given when p16+/HPV ISH negative SCC is found in the scar of a level V lymph node excisional biopsy with all other workup negative?
It is difficult to give a detailed and nuanced response in one sentence. I would double-check that this is also EBER-negative, and if so, I would suspect a non-HN mucosal primary, possibly skin (as these can be p16+ve HPV -ve). As such, I would focus treatment on the involved neck. It sounds like, d...