Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What radiation treatment volume and dose would you deliver to an isolated DLBCL relapse in the left eye s/p vitrectomy and intraocular methotrexate?
This is a case of secondary ocular lymphoma but the management of primary ocular lymphoma may be helpful to consider. For patients with primary ocular lymphoma, a significant number of patients present with bilateral disease at initial diagnosis or will relapse in the contralateral eye after unilate...
How does radiation to the breast in a lactating woman affect milk production?
Additional information regarding radiation and the effect on lactation: There is no evidence that breast fed babies are at increased risk of cancer. For women who have had radiation to the breast, in a published study, 80% had decreased lactation volume reported. Most women could produce mild, (55.6...
What is your approach for treating oligometastatic head and neck cancer in patients with a good performance status?
In patients with limited metastases and locally advanced head and neck cancer, we routinely offer definitive radiation therapy to the local disease, consider treatment of the metastatic site, and discuss addition of concurrent chemotherapy. The majority of these patients will benefit from locally d...
In vulvar cancer patients with a well lateralized primary s/p vulvectomy and ipsilateral LND meeting nodal-based criteria for adjuvant RT, would you consider RT to the ipsilateral groin and pelvis?
Risk of contra lateral node involvement for lateralized lesion is a function of the size of tumor, thickness of tumor and number of positive nodes in the ipsilateral groin (>2 node). If the contralateral node has not been assessed by dissection or SNLB then I would treat both groins all the time. If...
What lung constraints do you use for early stage breast hypofractionation?
The rationale for monitoring/constraining the ipsilateral lung is to avoid symptomatic radiation pneumonitis. That being said, I don't know if I have ever seen it in a patient where we are not treating nodes.Our official scorecard for whole breast conventional fractionation (40-42.56 Gy/15-16 fx) st...
Is it safe to hypofractionate for whole breast RT in patients with a BRCA 1/2 or CHEK2 mutation to chose to have breast conservation for early stage breast cancer or DCIS?
There is no evidence that hypofractionation compared to conventional fractionation results in higher acute or long term toxicities in patients who have these mutations. Since a majority of these patients may also be in a younger age group many clinicians may appropriately feel uncomfortable in offer...
What is the appropriate approach to manage a patient with triple-negative, locally advanced breast cancer (LN+) who progresses on neoadjuvant chemo-immunotherapy (KEYNOTE-522 regimen)?
Given the aggressiveness of the KEYNOTE-522 regimen, second-line chemo seems unlikely to be effective. Assuming the patient is currently not resectable, recommend breast RT concurrently with a well-tolerated radiosensitizer, e.g., capecitabine, dose, and fractionation depending on the presence or ab...
When treating with chemo/RT for bladder cancer, how concerned are you with small bowel dose constraints when boosting the bladder to 60 Gy?
This is an excellent question, and something we struggle with. DVH parameters are important considerations, but I also feel that sometimes we put too much emphasis on dose contraints; as if the sky will fall if you pass a threshold. Exceeding a parameter is no guarantee of good or bad outcome, but m...
What is the best radiation technique for treating Kaposi sarcoma involving the irregular surfaces of the toes and soles of the feet?
As in the treatment of most cutaneous malignancies with radiotherapy, it depends on the extent and location of disease. For small tumors or those on relatively flat surfaces, superficial or orthovoltage xrays can be a very simple and effective modality. Given that many radiation oncology departments...
How do you counsel patients with locally advanced malignancies who have ECOG 3-4?
I agree with @Dr. First Last and @Dr. First Last's comments about the implications of PS and specific situations where medical therapies have the potential to improve PS (heme malignancies small cell) and/or extend quality of life. I have two goals in this conversation. To make sure I understand the...