Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider repeat lumpectomy and external beam partial breast reirradiation for in-breast recurrent cancers?
Patients experiencing a localized recurrence in a breast previously treated with lumpectomy and whole breast radiation are appropriately offered salvage mastectomy with or without reconstruction as an acceptable standard. However, many patients wish to have options that preserve the breast. Repeat l...
Do you treat elective nodes in unresectable pancreas when treating with 15fx?
No, the standard has been to include only grossly enlarged node, so for now we do not include elective nodal irradiation. We will re-evaluate this practice when we have more data and are better able to assess the pattern of disease progression. We are treating over 100 cases a year uniformly, so thi...
When would you offer post-op radiation for the treatment of sebaceous carcinoma of the eyelid?
I think of them as poorly differentiated and it’s a location where margins are likely close so always.
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.