Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a high grade acinic cell carcinoma of the parotid with isolated recurrence in the ipsilateral neck s/p salvage resection?
For this patient with a neck recurrence and (presumably) no evidence of primary site recurrence who had been treated with RT previously to the parotid bed, I would treat ipsilateral neck levels IB, II, III, IV, and V. While IB coverage may be controversial, if the recurrence was in level II, I would...
What are the indications for adjuvant radiation for a resected acinic carcinoma of the parotid?
Although considered low risk, acinic cell carcinoma may be unpredictable. I would add postop RT for very close margins. PNI would depend on extent of nerve involvement. I would if it was extensive. I would not for LVSI. I would in the unlikely event of positive nodes.
How do you manage sexual dysfunction in women receiving ovarian suppression for breast cancer?
Asking questions about sexual dysfunction during routine follow ups is important. Many women may feel uncomfortable bringing up the issue. Next important to evaluate contributors such as physical complaints of dryness, dyspareunia, or libido issues, body image concerns, or relationship concerns. Phy...
What duration androgen deprivation do you recommend with salvage pelvic radiotherapy for pelvic node relapse after prostatectomy?
6 months ADT, 2 years ADT, 2 years ADT + abiraterone/prednisone seems reasonable depending on the circumstances. For example, early pelvic node recurrence for pT3b Gleason 4+5 would be a higher risk than a very late recurrence of pT2 Gleason 3+3.
How do you determine the timeline for healing after craniotomy prior to starting chemotherapy and radiation?
I typically wait at least 10-14 days post-op, always after neurosurgery has re-evaluated the craniotomy site for appropriate healing and has already removed staples or sutures.
What dose and treatment area of radiation should be given when p16+/HPV ISH negative SCC is found in the scar of a level V lymph node excisional biopsy with all other workup negative?
It is difficult to give a detailed and nuanced response in one sentence. I would double-check that this is also EBER-negative, and if so, I would suspect a non-HN mucosal primary, possibly skin (as these can be p16+ve HPV -ve). As such, I would focus treatment on the involved neck. It sounds like, d...
In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?
At this time, as there is no good evidence available, I would not recommend the use of hydroxycholoroquine prophylactically in cancer patients. It is unclear whether it would prevent contagion, probably not, and we still don't know if it will have any effect on the course of COVID-19. We expect ther...
Would you offer PMRT to a patient with pTisN1a left breast DCIS?
Macrometastases suggest there is missed invasive disease in the midst of 11-cm DCIS. For one macromet with only SLNB done, I would add CW and RNI as part of treatment, but if I had an ALND, then RT can be avoided.
What volumes and dose would you use for a chest wall recurrence in a patient who had previous mastectomy and completed only a partial prior course of PMRT?
I would treat it like a new course, provided cumulative brachial plexus dose constraints are met.
Is re-excision of residual disease ever itself an indication for PMRT?
This situation seems rather strange, but clearly the original surgery was inadequate, and re-excision still doesn't add up to optimal cancer surgery. Given these concerns, PMRT seems like a good idea. The fact that this is a right-sided lesion is helpful in avoiding cardiac RT in this young woman. T...