Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat a Stage I ER/PR positive HER2 negative breast cancer differently if it is associated with Lynch syndrome?
In reviewing the literature, there are a number of articles describing the risk of breast cancer in patients with Lynch syndrome such as this: (Nikitin et al., PMID 32547938). The cliff notes are that in patients with Lynch syndrome and certain mutations, there appears to be a small but definite inc...
Do you hold endocrine therapy during adjuvant breast radiotherapy?
I start endocrine therapy after RT. For one, I don’t think there is a rush to get endocrine therapy going and would rather focus on the patient being able to tolerate it for the long term. And two, if radiation works best on quickly dividing cells, I don’t want to stunt their proliferation (which we...
Do you start systemic therapy for patients with previously localized HR+ breast cancer developing solitary bone metastasis which is now triple negative if there are no other sites of disease after metastasis-directed radiation?
I would start chemotherapy because of the triple-negative status of the metastasis. This is a patient who initially presented with hormone receptor-positive breast cancer and subsequently developed an isolated bone metastasis that was triple negative. The question of systemic therapy post-localized ...
Is there data that shows that late side effects change from 5 year follow up to 10 year follow up when comparing iso-effective doses of conventional and hypofractionation for breast cancer?
Thank you, this is an interesting and relevant question given the emergence, for example, of 5-fraction (26 Gy) whole breast irradiation (WBI) as an option for patients based on 5-year results of the FAST-Forward clinical trial (Brunt et al., PMID 32580883). One of the most rigorous analyses I have ...
What are the alternatives to gonioscopy gel to protect the cornea when using internal eye shielding?
I typically use a prescription antibiotic ophthalmic ointment. Ask your pharmacy what they have available, and make sure the patient does not have an allergy.
Does a post-surgical hematoma in the breast affect your recommendations for partial breast RT?
More than seeding, the driving factor is the size of the hematoma. If small, it can proceed as planned with RT, but if large, sometimes it needs drainage or evacuation to help with healing. Any adjuvant RT treatment is driven by healing post-intervention for these large hematomas. ...
For patients who are incidentally found to have pT1a invasive breast cancer on excision for presumed atypia/DCIS without a sentinel lymph node biopsy, will you irradiate without the SLNB being performed?
Unless systemic treatment would change, I would not push for SNLN as the yield of SNLN for low volume IDC has to be weighed against the small but not insignificant risk of lymphedema and other side effects. When treating with whole breast, would include level 1 and 2 in RT field. In the era of syste...
How do you design pelvic lymph node treatment volumes for patients with tortuous or aberrant vascular anatomy?
So much of what we do comes down to a risk-benefit analysis, since it's really not possible to be sure that an individual patient will benefit from a proposed treatment. However, in this situation, if you would offer the treatment if the patient had normal anatomy, then I would offer it in the case ...
How would you manage a patient presenting with recurrent cT4 breast cancer?
This is similar to a question I answered on August 9, 2023. My answer then is very similar to the one now.There is little data on whether prophylactic re-irradiation of the chest wall is justified. I do not feel it will be beneficial if the second breast cancer represents a relapse of the first one,...
What is your regimen for treating a keloid with radiation alone?
Our institutional experience (Hoang, Aesthet Surg J 2017) has largely been with post-excisional RT, although at our institution we have on occasion treated definitively with RT alone. We do not have a standardized regimen for primary RT at our institution and the Malaker et al article is the only pu...