Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage incidentally identified pituitary lesions on brain imaging?
Pituitary lesions are among the most common incidentalomas seen on brain MRIs. Various studies cite numbers as high as 10- >30% for pituitary lesions found incidentally on brain imaging, with the higher incidence rates emerging in the era of high-resolution MRIs. In pediatric neurology/neuro-oncolog...
Do you ever consider a third course of CNS radiation to the same area for an in-field recurrence?
I’m assuming this is for brain metastases? If so, would be helpful to know how long and interval time of the first and second RT treatments. Would discuss this at our brain mets tumor board. Any particular reason why not surgical or LITT candidate? If this patient has a good KPS, no or minimal extra...
What dose do you use for definitive treatment of squamous cell carcinoma of the cervical esophagus?
Our institutional preference is to employ a total dose to 70 Gy with concurrent chemotherapy for squamous cell carcinoma of the cervical esophagus, because a local failure in would require salvage surgery with pharyngo-laryngo-esophagectomy. The role of dose escalation in squamous cell carcinomas of...
Would you offer partial breast radiation for bilateral DCIS?
Yes, would offer APBI
Would you recommend PMRT to a clinically node positive (biopsy proven axillary node and indeterminate single IMN node) BRCA positive patient with multiple medical co-morbidities including scleroderma and ILD who is treated with neoadjuvant chemotherapy (NAC) and mastectomy who converts to ypT0/ypN0?
Given pathological complete response and comorbidities, I would favor the omission of RT. While not a clear B-51 case, if you think IM was involved, given the totality of the situation omission is how I would go as long as post-chemo MRI showed stable or smaller IM node.
Would you prefer SBRT or fractionated radiation for a sacral peripheral nerve sheath tumor?
For a sacral peripheral nerve sheath tumor, I would favor SBRT (Stereotactic Body Radiation Therapy) over fractionated radiation due to its ability to deliver a high dose of radiation precisely to the tumor while minimizing damage to surrounding healthy tissues, especially in a sensitive area like t...
Under what circumstances would you consider omitting radiation in patients with early stage, unfavorable (bulky) Hodgkin Lymphoma?
We should first acknowledge that combined modality therapy improves progression-free survival in early-stage HL compared with chemotherapy alone. Stated more succinctly- if you give combined modality therapy, there is a lower risk of relapse; if you give chemotherapy alone, there is a higher risk of...
When treating inguinal lymph nodes in the setting of pelvic RT, what is your preferred setup in order to minimize dose to the penis?
I have tried a variety of different setups but have found that building a scrotal shelf works the best. The patient is set up supine in the frog leg position using your immobilization method of choice. I then use a custom moldable headrest and place it against the perineum to serve as a shelf for th...
What is your approach to a patient with incidentally found DCIS or invasive disease after a breast reduction?
Typically, in these cases I will give standard whole breast irradiation (40/15). I have not boosted as it's often unclear where the boost target is.
Can radiation to the breast be given in the setting of prior radiation for Hodgkin's lymphoma?
Based on previous dose and volume (as most people are getting ISRT and between 20-30 Gy), either whole breast or partial breast RT are usually options. One concern I have is the increase IBTR which is most likely new primary in these patients because of prior RT exposure (akin to BRCA mutation).