Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What do your treatment volumes include when treating a resected mucoepidermoid carcinoma of the parotid gland with close, but negative, margins where recurrence would require sacrifice of branches of the facial nerve?
Following general principles, the 3 targets are tumor bed, operative bed and subclinical non-operative bed. Ideally, the patient has preoperative imaging, as unfortunetly it is still common that these pts are operated without oncologic assessment. As the scar is part of the operative bed, it is cove...
Do you routinely offer a stereotactic boost to patients with bulky (>3cm) residual brain metastasis after whole brain radiation for multiple brain metastases?
In general, bulky tumors are resected out. If for some reason a patient with a bulky tumor does receive WBRT for a bulky tumor, I would wait a month or two after for a repeat MRI. If the tumor does shrink it should provide some room to dose escalate.
What is the role of consolidative durvalumab and prophylactic cranial irradiation in patients with stage I small cell lung cancer?
In the ADRIATIC study, stage I or II limited-stage SCLC comprised only about 12% of patients randomized. The point estimate of HR regarding survival benefit was 0.92, with a wide confidence interval exceeding 1.0 (upper range more than 2). I do not recommend durvalumab consolidation for those with s...
How do you approach radiation treatment of extramammary Paget's disease of vulva, diffusely involving the urothelium and the periurethral glands?
Very unusual case. Presuming it has invasive disease, would also check HER2/neu status to see if there is any value of indication with chemo and anti-HER2/neu therapy. Will plan definitive chemo RT treating vulva, vagina, urethra, and bladder (if involved) to 66-70 Gy to gross disease and prophylact...
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...