Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach treatment of an optic nerve sheath meningioma presenting with complete ipsilateral visual loss?
Radiosurgery to prevent further tumor growth of an optic nerve sheath meningioma in a patient with complete ipsilateral visual loss can technically be accomplished. It is prudent to not include the chiasm nor the very proximal optic nerve due to Wilbrand's knee of the optic chiasm (where crossing fi...
What would you recommend for early stage vulvar cancer with close margins?
With negative sentinel LN's in an early stage patient, I would try to avoid the use of radiation if possible. Re-excision with a clear margin of 1-2 cm, extending to the deep perineal fascia, should be adequate to give a high rate of local control and cure, in the absence of other negative prognosti...
What is your preferred radiation technique for treatment of skin cancer of the eyelid?
Beam and internal eye shielding (between globe and eyelid)
Is the phase 2 data regarding neoadjuvant cemiplimab in cutaneous squamous cell carcinoma sufficient to adopt for all patients or will you await phase 3 data?
The current data are quite compelling, but not sufficient to adopt for all patients. We need to see the long-term recurrence and survival rates from the phase II study and also perform a confirmatory phase III trial with a survival endpoint. Unless this treatment approach results in equivalent to im...
What criteria do you use for replanning with a new CT simulation for patients being treated definitively for head and neck cancer?
Whenever nodal shrinkage or weight loss reduces the fit of the mask we make a new mask in same position and re-calculate doses using existing IMRT beam and dose fluences. Tumor dose never reduces based on our experience, and the main issue are doses to organs. Skin dose may increase and it may be wo...
For which patients, if any, do you typically order additional imaging workup for staging in early-stage breast cancer?
Many studies have shown the true-positive rate of distant metastases on pretreatment imaging to be a few percent (at most) for patients with Clinical Anatomic Stage I-II cancers. The false-positive rate is much higher. Hence, such imaging should only be used when patients have suspicious symptoms or...
For gastric cancer receiving FLOT perioperatively with negative margins but multiple positive nodes, do you offer postoperative chemoRT?
This is a question that is starting to come up frequently in clinical practice.The design of the FLOT study does not consider radiation or other changes in treatment if there is a poor response to the pre-operative chemotherapy. Purely based on the study, everyone would get post-operative FLOT, rega...
How do you define LVSI in breast cancer?
I don’t think there is a structured way of reporting but the variable used by pathology is: LVSI present Uncommon, but reported as extensive LVSI (LVSI present both within and outside main tumor) Dermal lymphatic invasion
What is the optimal time to wait prior to surgery following radiation therapy for rectal cancer to maximize the pathologic complete response rate?
Great question- and this is an even more interesting question in the era of TNT, with variables of SC vs LC RT and sequencing of induction vs consolidation chemotherapy. Especially with the question of—how do we best maximize the chance of a pathCR? I think starting with that question is the first s...
In a patient with a mediastinal recurrence following lobectomy for early stage NSCLC, what would be your treatment volume?
In a patient who develops an isolated failure in a regional nodal site after surgery, I would treat in a manner similar to inoperable stage III NSCLC (concurrent chemotherapy and radiation therapy). Under most circumstances, I would include some "selective" elective nodal coverage based on a number ...