Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat a pleomorphic sarcoma of the pelvis post-operatively?
This is a difficult question to answer directly because it depends very much on the precise anatomic location of the tumor and the extent of surgery. A pleomorphic sarcoma in the pelvis could represent: Lower retroperitoneal pleomorphic sarcoma (which can include the pelvis) Arising from the pelvic...
What is your preferred dose/fractionation for WHO grade 1 meningiomas?
This question includes many offshoots which impact optimal dose and fractionation, such as target volume, anatomic locale, presence of edema, surgery and its extent, and recurrence status. Patients with small (<10 cc, perhaps even <7.5 cc) supposed (unresected) WHO grade 1 meningioma do very well wi...
How do you manage a cervical cancer patient on anti-coagulation for pulmonary embolism requiring interstitial brachytherapy boost?
Have done with IVC filter and switch to heparin days prior to the procedure so that can hold anti coagulant for the procedure and epidural placement for analgesia.
Would a finding of isolated tumor cells on SNB impact your decision to offer omission of radiation in a patient with breast cancer who is otherwise a candidate?
ITCs raise our eyebrows, for sure, but are not technically a reason to treat. As this was not recorded in the CALGB study and the majority of patients did not have any axillary evaluation, it is quite likely a portion of patients had ITCs, and yet still did not have excessive rates of recurrence.Tha...
Do you recommend additional nodal boost in patients with suspicious internal mammary nodes that respond completely after neoadjuvant chemotherapy?
Our standard practice is to boost undissected regional nodes (IMC, ICV, SCV) that completely respond radiographically, an additional 10 Gy after regional nodal irradiation, and boost those that persist on imaging after chemotherapy 16 Gy. If the radiographic complete response was associated with sig...
How would you approach adjuvant RT for porocarcinoma of the face?
The reported outcomes after surgery in the published literature are all over the place. With some saying surgery alone is adequate and others reporting that these have a high incidence of local, in-transit, and regional recurrence. I tend to treat these with Merkel cell carcinoma volumes.
What are indications for adjuvant radiation for well differentiated non-intestinal adenocarcinoma of the nasal cavity?
I would irradiate all except a well defined T1N0 resected en bloc with negative margins.
Would you omit radiation to the R0 tonsil tumor bed after TORS for p16+ tonsillar SCC when delivering adjuvant radiation to the neck due to + lymph nodes found intraoperatively?
No This is a strategy being advocated particularly from centers that are strongly surgery driven. There has been at least one publication, but the data so far is with small retrospective sample sizes. There is a certain historic irony, as when postoperative radiation was initially advocated in the 1...
Do you require both biopsy of the primary in addition to nodes in your practice for HNC?
While it is ideal to get biopsy from a putative primary and putative nodes, I do not think that it is needed. In cases with a known mucosal H+N primary and several PET avid nodes, I would almost never request biopsy and just treat those as gross disease. The more challenging situation is when you ha...
In stage 4 hilar cholangiocarcinoma, after stenting the biliary tree is there value in radiating the hilar area in addition to systemic therapy so as to maintain patency of the biliary system for a longer period of time or do you depend on the systemic therapy and the stenting alone?
In the setting of metastatic hilar cholangiocarcinoma, biliary patency is one issue but the greater issue is colonization of the biliary tree with gut flora that leads to repeated bouts of cholangitis, and progressive biliary sclerosis that happens regardless of the use of radiation. These patients ...