Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat epithelial-myoepithelial carcinoma of the parotid following resection with clear but close surgical margins?
I would try to get the pathologist to nail down a grade. Low or intermediate, I would follow if close but negative. High, I would treat. I think that they are usually low grade. Really close on the 7th nerve, (<1-2 mm), I’d treat.
Would you offer adjuvant radiation to a low grade myoepithelial carcinoma of the soft palate with positive margins and no other aggressive features?
This situation is relatively more common when the surgical procedure was an excision biopsy for diagnosis rather than a planned oncological resection. The usual first Q in this scenario is whether the surgeon could go back and perform a wider excision without compromising function. This is a tricky ...
If a patient with locally advanced cervical cancer cannot receive brachytherapy following 45Gy to the whole pelvis, how do you optimally deliver your boost?
One should be very cautious, as in our experience the situation where you can't do brachytherapy is very rare. There is a trend in the country to use a non-brachytherapy boost as it is more accessible but this approach can lead to worse outcomes. See Dr Viswanathan's paper recently published in the ...
Do you recommend definitive chemoradiation for unresectable gastric adenocarcinoma in a medically unfit patient?
Definitive is probably not the best term for what can be done. Only palliative doses are possible because the stomach is so sensitive, the GTV is difficult to clearly define, impossible to see on CBCT, the stomach changes shape from day to day, and moves with respiration. There would only be a less ...
Which chemotherapy should be held while delivering palliative radiation?
Any chemo that is considered a radiosensitizer should be considered as potentially increasing toxicity during palliative RT, and the question of whether to hold these agents should be carefully considered at the very least. This includes but is not limited to: doxorubicin, gemcitabine, taxanes, 5FU,...
What data support the use of continuing GnRH therapy "backbone" in metastatic castration resistant prostate cancer (mCRPC) receiving additional therapies?
The short answer is that ALL phase 3 trials of life-prolonging therapies now approved in mCRPC required ongoing ADT (medical or surgical) and there is not a single positive life-prolonging phase 3 trial that did not do this. Until then our strongest evidence is to follow how these trials were conduc...
How long would you wait before considering additional treatment to the same site if bone metastasis pain fails to improve after 8 Gy x 1 fraction?
There is unfortunately very little published evidence to help guide the answer to this very important question. It's potentially a big topic, so I am going to attempt an answer from a spine reirradiation perspective (Reirradiation of other sites such as weight-bearing long bones may have different c...
How do you approach postoperative radiation for small oral cavity cancers cases with limited risk factors?
LVI is considered a minor risk factor in HNC, similar to PNI, but data regarding its exact prognostic effect and whether it alone deserves adjuvant treatment are scant. For example, a large MSKCC of OC patients found LVI in only 11% of patients, compared with 25% of patients with PNI (Zaromi et al.,...
How do you define your treatment volumes when treating a patient with post-mastectomy radiation therapy?
There are several ways to define treatment volume with PMRT. 1) The way that I have handled these cases is to wire out the chest wall and chest wall scar at sim and use this to create my treatment volumes rather than contouring. If the drain site is in the volume I cover it but otherwise dont extend...
How would you manage a prolonged treatment break in the middle of lung SBRT for early stage NSCLC?
I’ve never had this particular scenario occur but I likely wouldn’t change total dose or fractions unless we are talking about an essentially new course type of delay. Not lung but there is data from the University of Michigan in 2019 looking at an intentional 4-week break after fraction 3 of SBRT f...