Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the best way to proceed in anal cancer surveillance if PET avidity of the primary is reduced, but still avid at time point <6 months s/p chemo-RT?
I would do serial physical exams every month or two and trust that more than PET-CT. If it continues to regress, then continue to follow. If after 6 months it has stopped regressing and you can feel something, can biopsy.
Would you change treatment approach for rectal cancer with an associated intussusception?
If the patient has obstruction, I probably would favor surgery first. If not, then I'd treat it as usual. It's a judgment call though.
Would you offer FAST-Forward for a metastatic breast cancer patient with breast implants needing palliation of symptomatic breast lesions?
This is a common scenario. If symptomatic and close to the surface/skin, I would favor 30/10-39/13 with 1 cm bolus to get skin dose where needed; I would be a bit concerned about 5.2 Gy/fraction and that amount of bolus. If larger, deeper lesions that are causing symptoms, 26/5 is fine in my opinion...
Does histology (e.g., lobular vs ductal) impact your decision to offer omission of RT to women with breast cancer who are otherwise candidates?
Histology doesn't influence me as long as IHC is favorable (although with 5 fraction RT, it is easier for patients to get to treatment than to observe).LCIS in specimen doesn't influence my decision as well.Although no tumor on ink is adequate for patients getting RT, that may not be true for the om...
For HPV-negative head and neck cancer of unknown primary after proper work up and biopsies, what mucosal surface(s) do you cover?
The treatment for CUP has evolved quite a bit, and frankly, I don't think there is a true standard. Even in our group, we often don't have consensus with regards to whether to even treat mucosa and if treating, which sites.Very weak data suggests that whether you just treat the involved neck or chas...
Is there increased risk with lung SBRT in a patient who has a mild asymptomatic pneumothorax in the field after CT-guided needle biopsy?
I'd be curious what others thought but my quick thought is probably not. If I can extrapolate (i.e., make up) what might be the course of events and what you might want to consider... You send a patient for bx to confirm malignancy and see them right after for sim. The patient is noted by IR to have...
How would you manage a patient with a small Type A Thymoma, who is not a candidate for resection due to medical co-morbidities?
Surgical resection still remains the gold standard for thymic tumors, with the ultimate goal of achieving an en bloc removal of the thymus and perithymic fat without tumor capsule violation. Nevertheless, there is mounting evidence that minimally invasive surgical thymectomy approaches (robotic-assi...
Do you modify your target volume for treatment of trigeminal neuralgia confined to a single branch of CN V?
Short answer: NO. Target is preferable to the cisternal segment and we have always cusped into the DREZ on the first treatment. Distal treatment nearer the Meckel's Cave and even beyond becomes more akin to a Rhizotomy and will have more likelihood of sensory loss and ultimately deafferentation pain...
For patients that fail initial SRS for trigeminal neuralgia, what factors do you consider when considering re-irradiation?
Failure within 6 months/No response: Is vascular compression present? Yes = Consider Microvascular decompression. If contraindicated repeat SRS to 50 Gy. No + then was the nerve clearly visualized on MRI? Yes = Possible repeat SRS to 50 Gy. No = then that could be a cause for failure, consider ret...
Do you treat bilateral trigeminal neuralgia with SRS?
Yes, but I treat the side with more severe symptoms first and treat the other side 6 months later. I do not make dose modifications. I have treated some patients with bilateral trigeminal neuralgia in this fashion with no issues.