Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach a T1N1 NSCLC with a small peripheral primary tumor and single hilar node in a patient not fit for concurrent chemo or surgery?
If the patient were not a candidate for surgery or chemotherapy, then I would favor hypofractionated radiotherapy to 60 Gy in 15 fractions to both the primary and the hilar lymph node based on UTSW phase I data. If the patient may be a candidate for immunotherapy, then I would strongly consider enro...
For a young patient with high grade pT1N0 medially located breast cancer, under what circumstances would you include the IMN in your treatment fields?
For patients treated with upfront surgery who are T1N0, I personally do not radiate the lymph nodes, even in young patients with high grade lesions. An exception could be in patients with extensive LVI where the likelihood of nodal involvement is higher. For patients with initially more advanced dis...
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...