Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For consideration of empiric lung SBRT without pathology, do you use a preferred nomogram to guide this decision?
I feel most comfortable offering empiric SBRT when the following criteria are met: Growing PET avid Not likely a non-malignant condition Compelling medical or patient-specific reason for no biopsy Patient understands the implications of proceeding without a biopsy
Do you routinely perform a breast boost after whole breast radiation?
In the setting of close margins, I would utilize a boost (after confirming that re-excision is not planned). More generally, I boost all patients <age 50 and older patients with higher risk features such as high grade disease, hormone negative disease, larger tumor size, and close margins where re-e...
Are there any accruing trials in the U.S. evaluating selective use of radiation after mastectomy in early stage breast cancer?
The SUPREMO trial results have not yet been presented or published. There are no trials currently open in the United States randomly allocating patients who have had up-front surgery between PMRT and observation. There is such a study in South Korea, entitled "Postoperative Radiotherapy in N1 Breast...
What dose/fractionation would you use for a multiply recurrent and now unresectable ameloblastoma involving the masticator space, pterygopalatine fossa, and right maxillary sinus?
70 Gy/35 fractions. If SCC component, treat the neck.
For a T1 true vocal cord cancer that is p16+ would you use standard dose (63 Gy in 28 fx) or use a lower dose of radiation?
Same.
Is it reasonable to treat a solitary plasmacytoma of the lung parenchyma with SBRT?
I have only treated one patient with solitary plasmacytoma of the lung over the past 15 years of doing lung SBRT. It is an extremely rare and unusual disease presentation for myeloma. Given the radiosensitivity of myeloma, I opted for 30 Gy in 5 fractions, which resulted in a completed response in t...
Would you re-RT for heterotopic ossification if the first course of postoperative radiation failed to prevent HO formation?
I routinely offer a second course.After the first course, the risk of secondary malignancy approaches zero - i.e., there are no documented cases in the literature. Seegenschmidt's paper with about 6,000 treated hips reported no secondary malignancy at 10-year follow-up. Now, what about after a secon...
For a patient s/p TORS with indications for adjuvant radiation, how does your management change with persistently elevated ctHPVDNA?
At this time, it's a bit challenging to make any meaningful treatment changes based on positive post-operative ctHPVDNA. But it certainly raises my suspicion - I would take a close look at the CT simulation for any potential grossly positive nodes (especially a retropharyngeal node that may not have...
In a young woman with large invasive breast carcinoma (case: pT3, lobular) s/p skin sparing mastectomy with positive anterior margin, what is the practical role for re-excision with or without PMRT?
The case has many nuances. Is the margin positive focal or diffuse? Can a surgeon confidently go back to excise positive? If not, would proceed with PMRT and boost quadrant where disease was present before surgery. Counsel the patient about reconstruction complications and the need for additional su...
How would you approach a radiation-induced angiosarcoma of the breast after mastectomy with negative margins?
I almost always offer adjuvant RT based on high risk of locoregional recurrence. If > 10 years from RT, I consider standard fractionation to 60-66 Gy. If < 10 years from RT, I will often given BID (1.5 Gy BID to 50-60 Gy)