Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How are you incorporating 68-Ga Dotatate PET scans in the management of grade I/II meningiomas?
Thank you for posing such a leading-edge question. I surmise its answer may have a rather different din a few years from now. However, to date, I am not using DOTATATE PET for meningioma. This is due partly to habit, availability, insurance constraints, and the specific clinical circumstances of the...
How do you manage an adult primary rhabdomyosarcoma of the lung/mediastinum?
COG trials include all patients <50 years old. The 5-year OS of patients treated in the most recent COG trials is over 70%. So, I would recommend you treat the adult patients per COG protocols if you do not enroll your patients in the COG trials. To manage rhabdomyosarcoma, we need to know the risk ...
How do you treat localized esophageal carcinoma in patients who are unwilling or unable to undergo chemotherapy or surgery?
This is a question that comes up occasionally in clinic. My viewpoint is generally based on the prospective data that we have. Of course, the RTOG 85-01 study showed 0% long-term OS with definitive RT vs CRT. Additionally, the Intergroup 0123 study showed no evidence of improvement with higher dose...
Do you leave the tracheostomy tube in place or take it out during each head and neck cancer radiation treatment?
I leave it in and don't bolus. I take it that we are referring to post total laryngectomy. If not, the patient should have had one. If so, bolus is likely unnecessary because the mechanism of a stomal recurrence is likely a level 6 node. Cheers!
When is the coverage of tracheostomy site required for Head & Neck cancer radiation therapy and to what dose?
I always take the stoma to 54-60 Gy, and boost to 66 Gy in case of any of the following: emergent trach placement subglottic extension anterior soft tissue involvement (i.e., through-and-through thyroid cartilage involvement and/or actual soft tissue involvement anterior to thyroid cartilage) conta...
When do you consider boosting the the tracheostomy site in post operative head and neck cancer patients?
I was taught that the stoma was included and treated to a subclinical dose (50 gy at 2 gy) in essentially all cases when post laryngectomy radiation was performed. The classic indications were detailed in the Fletcher texts, and a relatively old paper from MDA by Yuen et al. These include: extensive...
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...