Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Why is pT3 not a PORT indication for glottic larynx in the NCCN guidelines?
pT3 glottic larynx is a somewhat unusual finding in typical clinical practice since modern imaging is quite good at detecting T3 lesions and most of these will be treated with definitive chemoradiotherapy. Downstaging from cT4 to pT3 would also be unusual because cT4 findings on imaging are fairly s...
When would you consider larynx preservation in patients with T4N+ SCC of the larynx?
Most T4 patients should not undergo CRT alone. Surgery, followed by postoperative radiation, remains the standard of care for most patients with T4 disease. For patients who decline surgery, concurrent CRT is the best alternative and is superior to radiation alone. However, it is likely still inferi...
What is your approach to adjuvant radiotherapy of laryngeal cancer after laryngectomy and flap reconstruction?
Same as without a flap. Try to start within 6 weeks of surgery.
How would you manage a scalp squamous cell carcinoma s/p Mohs with high risk features who underwent placental grafting to expedite the healing process?
When the plastic surgeon says it is safe to deliver radiotherapy, proceed.Clearly, the primary method used here in this case was surgery, so those physicians carry the water. What should be avoided is the situation where the skull becomes exposed, so the graft's health is important. Various systemic...
Would you offer ultrahypofractionated 5-fraction whole breast only for a women with ER-/HER2+/cN+ disease with pCR following neoadjuvant systemic therapy?
If the plan is to treat breast only then 26 Gy in 5 with and without boost is fine. The philosophy of treating RNI would vary based on the interpretation of 5 years of B-51 data.
When treating chestwall + RNI with VMAT, how much do you crop the PTV into lung as is done with the PTVeval in 3D contouring guides?
We don’t edit PTV for VMAT plans. Chest wall contour (CTV) only includes pec muscles (not intercostal muscles or ribs like RTOG ATLAS) so the amount of PTV (3-5 mm expansion of CTV) overlap with lung is minimal to begin with. We do use a dummy bolus to create skin flash.
How do you prevent and treat lymphedema following head and neck XRT?
I have had success over many years using sodium selenite 250 mcg, 2 capsules daily, for patients with subacute supraglottic edema after head/neck radiotherapy. The majority of patients report a moderate improvement in symptoms of raspy voice and mild dysphagia. This is clearly not appropriate to man...
How would you determine ipsilateral vs bilateral neck irradiation for early stage, well lateralized nasal cavity SCC?
In general, anterior nasal cavity tumors drain to level IB through the facial nodes and to level II, while posterior cancers drain to level II as well as retropharyngeal (VIIA) and retrostyloid (VIIB) nodes through the nasopharynx. Whether there is a difference in contralateral risk for well-lateral...
Would you offer elective RT for an early stage, high grade penile cancer sp partial penectomy who cannot undergo groin sampling/SN biopsy?
The guidelines for adjuvant treatment of penile cancers are all over the place because of lack of any good data (rarity of disease). We have extrapolated from vulvar ca and considered adjuvant RT treatment with similar philosophy. (Prophylaxis to bilateral groin for microscopic disease, if surgical ...
Is stage I B/L breast, ER+ cancer a contraindication to breast radiation omission after breast conservation surgery?
There is no contradiction as long as each lesion meets the omission criteria