Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend radiation or chemoradiation in a patient with cholangiocarcinoma s/p surgery and adjuvant treatment with single hepatic metastasis 3 years later?
Challenging case and worthy of tumor board discussion. I would likely start systemic therapy, and if response, consider regional therapy with resection or SBRT, assuming the hepatic function is adequate (keep in mind, TARE can cause liver disease). I have one patient in a similar situation, now > 5 ...
Should capecitabine be administered at a specific time prior to RT in pre-op chemoradiation treatment for rectal cancer?
We looked at this question and published our analysis in 2007. We looked at the timing of administration and radiation delivery. The dosing of capecitabine was standardized, and the radiation timing was random. The 2-year local control, distant control, and disease-free survival were nearly identica...
Which patient subgroups do you plan to omit regional nodal irradiation for, given the publication of NSABP B-51?
I will await more data with subgroup analysis prior to changing my practice pattern.
Would you offer SBRT as an alternative to surgery for an atypical carcinoid lung tumor?
As this question pointed out, small series do show a likely benefit to SBRT for an inoperable atypical carcinoid. Two general points to make here. First, RT has been used for many years to treat atypical carcinoids when the tumor or patient characteristics don't support surgery. Second, we treat man...
Do you use any dose constraints ovaries/uterus in premenopausal women receiving pelvic RT and hoping to preserve fertility?
For ovaries I use the principle of as low as we can achieve based on CTV and PTV. If possible have used number of 5 Gy or below. Based on ovarian ablation studies for breast cancer 15-20 Gy would ablate ovaries
Are there guidlines for elective coverage of nodal basins in head and neck for skin cancer removed in the area?
Practically, I find the following tool from Aukland very helpful.They mapped melanoma lymphoscintigraphy data onto an interactive tool that allows you to select different locations and estimate the nodal drainage. https://sites.bioeng.auckland.ac.nz/hrey004/head/ https://sites.bioeng.auckland.ac....
How would you treat a perineural IgG4-RD with persistent paresthesia?
Perineuritis is an uncommon manifestation of IgG4-related disease (IgG4-RD), but it does occur. In most cases, this is an incidental finding that is not associated with symptoms or nerve dysfunction. This is most often observed in branches of the trigeminal nerve (e.g., infraorbital nerve, frequentl...
In a patient with bilateral neck level II small cell carcinoma with no apparent primary after workup with plans to receive concurrent cisplatin/etoposide, what would be your treatment volumes?
Extrapulmonary small cell cancer, like its lung equivalent, is highly sensitive to chemotherapy but has a high rate of metastatic disease, which is the primary site of failure, with median DFS of about 6 months. If this patient achieves clinical CR after chemotherapy, I would forgo RT. I would consi...
Would a high Decipher score affect your recommendation regarding the addition of ADT to XRT in a favorable intermediate risk prostate patient?
The simple answer is YES.To walk through why...1. Trials like RTOG 9408 demonstrate that there is a metastasis and OS benefit in Intermediate Risk disease from the addition of short-term ADT to RT.2. Later work from many groups showed that intermediate risk is a very heterogeneous cohort. This shoul...
Would you favor radiation or immune modulating treatment like imiquimod to treat an uncomplicated basal cell carcinoma on the nose in an elderly patient for whom you'd like to avoid surgery?
If my patient was concerned about deformity, with 10 to 15 years of life remaining, unquestionably, I would recommend radiation.