Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you palliate a metastatic lesion abutting a joint with an associated effusion?
I don't know that there is data for this - not that I could find. Bone metastases themselves cause pain due to multiple factors - mass effect, inflammation, and microenvironment changes. I'd guess the effusion is potentially due to the existence of the metastases (an inflammatory reaction), rather t...
Do you use any thyroid dose constraints for head neck radiation planning?
I do not constrain the thyroid. Careful monitoring post-operatively for hypothyroidism and appropriate thyroid replacement is reasonable. There is another, more theoretical concern that I have in that based on a Childhood Cancer Survivor Study Analysis, intermediate RT doses to the thyroid (10 - 30 ...
What dose would you use to treat unresectable basal cell carcinoma of the vulva?
I would make sure not mixed pathology like basosquamous. If pure basal then would treat primary alone with dose and volume like BCC of skin.
Will you treat brain mets with SRS in patients who cannot undergo MRI?
I agree with all of the previous comments. In addition, I'd like to add my own anecdotal experience. I saw a patient with widely metastatic melanoma who underwent head CT instead of an MRI brain due to the presence of pacemaker. There was a nodular enhancing focus read as suspicious for metastasis, ...
How would you approach treatment failures with squamous cell carcinoma-keratoacanthoma-type lesions that did not respond to a standard SRT regimen after many sessions?
Most keratoacanthoma-type cutaneous squamous cell carcinomas that I see are bulky, and superficial radiotherapy (SRT) would not provide an adequate depth of radiation penetration to eliminate the carcinoma cells. If radiotherapy is being used for a bulky tumor like this, a higher energy form of more...
In patients with early-stage follicular lymphoma undergoing definitive RT, do you approach grade 3a disease any differently than grade 1-2 (radiation dose, fields/margins, systemic therapy)?
Our philosophy is based on whether it is grade 3A or 3B. If it is 3A, then we treat like low grade lymphoma with RT (similar dose and principle) but if it is 3B, then treat with chemotherapy +/_ RT like diffuse large B cell lymphoma.
Is there evidence to support or argue against intermittent fasting for cancer patients?
This is a complex topic with many permutations of dietary interventions similar to fasting such as calorie restriction and “fasting mimicking”, but as it pertains to pure fasting, I know of a few small studies which characterize fasting around the time of chemotherapy infusions (Raffaghello et al., ...
Would you boost a resected axilla if extra-nodal extension is found in a patient with breast cancer?
The data on ECE for breast suggests it increases the risk of recurrence in undissected axilla or supraclav region. We don’t boost ECE region and most of the time don’t even include the dissected axilla with ECE in treatment volume unless the dissection is inadequate.
How would you treat a primary angiosarcoma arising in the skull, excised with initial excisional biopsy?
I would try to get some more information first. Is this a cutaneous primary invading into skull, or a lesion arising primarily in the skull? Is there any evidence of violation (tumor or iatrogenic) through calvarium such that dura is threatened? I would stage with a careful skin exam for any cutaneo...
Would you use bolus in patients s/p mastectomy and reconstruction if they had dermal involvement?
Pathological dermis involvement is a risk factor of LR and I would use bolus for this situation.