Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage residual hyperpigmentation after breast irradiation?
There are definitely options, including modified Kligman formula cream (4% hydroquinone, 0.05% tretinoin, and 0.01% fluocinolone acetonide) for 8 weeks as initial treatment; this - or some iteration of it - is what is typically used for cases of post-inflammatory hyperpigmentation (PIH) or melasma. ...
What treatment fields and dose do you use in the treatment of postoperative angiosarcoma of the scalp?
This is hard disease to treat with high propensity of local and distant relapse . The volume of treatment varies based on extent of involvement as most of the time it presents as diffuse disease and you end up treating almost entire scalp. But if lesion is small one can treat with limited field with...
What dose/fractionation would you recommend for a prostate patient who previously received 1 of 5 planned fractions SBRT in 2020?
Tough case and a reminder of all the continuing fallout from the pandemic. My TL;DR is it's fine to deliver full dose and basically ignore the prior RT delivering as conformal and safe a plan as you can this time around. A couple more wordy thoughts:1. What's the benefit?For a man with very high-ris...
How do you approach the discussion and decision-making regarding surgery vs SBRT for stage I NSCLC in patients who are candidates for both?
I agree with Dr. @Dr. First Last that it requires a very nuanced and personalized discussion. Our Yale approach (led by Frank Detterbeck) has been detailed in a 4-paper series in the Journal of Thoracic Disease 2022 (overview and SBRT/ablation focus), with the general paradigm balancing short-term, ...
What chest wall boost volume do you use for patients with inflammatory breast cancer?
I will typically boost the scar + 2-2.5 cm. It's also important to make sure the scar boost volume was all included in initial tangential volumes.
Would you offer partial breast radiation to a young breast cancer patient with BRCA 1 if all other criteria are met?
I would favor whole breast RT as the incidence of recurrence/new primary is high and there is data to suggest RT to whole breast reduces that incidence Evron et al., PMID 30475942
How do you approach elective cranial nerve target volumes for head and neck cancers to account for potential retrograde or anterograde spread along cranial nerves?
In general, I’m electively covering cranial nerve branches in the setting of an advanced skin cancer with at least microPNI, an adenoid cystic carcinoma, an advanced paranasal sinus tumor with micro or clinical PNI or a nasopharyngeal carcinoma with clinical PNI. Occasionally there’s an advanced gin...
In a locoregionally advanced breast cancer with multiple positive surgical margins, how safe is it to wait for a re-excision vs treating upfront with comprehensive RT if surgery cannot be done the short term due to the COVID outbreak?
Agreed, higher radiation dose will not replace negative margins. Obtaining negative margins is ideal. If the patient is a systemic therapy candidate, I would agree with @Dr. First Last and proceed with systemic therapy and then re-excision.
How would you recommend treating locally recurrent pancreatic cancer?
Referrals for these patients have been increasing over the last few years, most likely with the advent of more effective systemic therapy (or perhaps with the decrease of adjuvant radiation). I have not found much data to cite for these patients; but I have recommended stability/non-metastatic over ...
Do you omit consolidative RT in pediatric patients with intermediate risk, non-bulky Hodgkin lymphoma who have a rapid early response to chemotherapy?
Yes, if the patients meet the rigid requirements for response, which include a rapid early response (Complete response or very good partial response) after 2 cycles of ABVE-PC chemotherapy AND have a complete response at the end of treatment then the data suggests similar outcomes whether or not the...