Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you use any thyroid dose constraints for head neck radiation planning?
I do not constrain the thyroid. Careful monitoring post-operatively for hypothyroidism and appropriate thyroid replacement is reasonable. There is another, more theoretical concern that I have in that based on a Childhood Cancer Survivor Study Analysis, intermediate RT doses to the thyroid (10 - 30 ...
What dose would you use to treat unresectable basal cell carcinoma of the vulva?
I have treated one patient with 55 Gy in 20 Fx who is NED at 3 years post-RT. Had some acute RT toxicities similar to most vulvar cancers. Treated gross disease alone with small margin, as mentioned above.
Will you treat brain mets with SRS in patients who cannot undergo MRI?
I agree with all of the previous comments. In addition, I'd like to add my own anecdotal experience. I saw a patient with widely metastatic melanoma who underwent head CT instead of an MRI brain due to the presence of pacemaker. There was a nodular enhancing focus read as suspicious for metastasis, ...
How would you approach treatment failures with squamous cell carcinoma-keratoacanthoma-type lesions that did not respond to a standard SRT regimen after many sessions?
Most keratoacanthoma-type cutaneous squamous cell carcinomas that I see are bulky, and superficial radiotherapy (SRT) would not provide an adequate depth of radiation penetration to eliminate the carcinoma cells. If radiotherapy is being used for a bulky tumor like this, a higher energy form of more...
In patients with early-stage follicular lymphoma undergoing definitive RT, do you approach grade 3a disease any differently than grade 1-2 (radiation dose, fields/margins, systemic therapy)?
Our philosophy is based on whether it is grade 3A or 3B. If it is 3A, then we treat like low grade lymphoma with RT (similar dose and principle) but if it is 3B, then treat with chemotherapy +/_ RT like diffuse large B cell lymphoma.
Is there evidence to support or argue against intermittent fasting for cancer patients?
This is a complex topic with many permutations of dietary interventions similar to fasting such as calorie restriction and “fasting mimicking”, but as it pertains to pure fasting, I know of a few small studies which characterize fasting around the time of chemotherapy infusions (Raffaghello et al., ...
Would you boost a resected axilla if extra-nodal extension is found in a patient with breast cancer?
The data on ECE for breast suggests it increases the risk of recurrence in undissected axilla or supraclav region. We don’t boost ECE region and most of the time don’t even include the dissected axilla with ECE in treatment volume unless the dissection is inadequate.
How would you treat a primary angiosarcoma arising in the skull, excised with initial excisional biopsy?
I would try to get some more information first. Is this a cutaneous primary invading into skull, or a lesion arising primarily in the skull? Is there any evidence of violation (tumor or iatrogenic) through calvarium such that dura is threatened? I would stage with a careful skin exam for any cutaneo...
Given the criticism of GOG 88 and in light of various other recent data, would you deliver definitive XRT in place of inguinal lymph node dissection?
Despite GOG 88 findings, a number of retrospective studies have suggested that regional prophylactic RT is an effective method of preventing groin recurrences with minimal morbidity when appropriately delivered. (Combined across retrospective series, the incidence of groin recurrence following treat...
How does metaplastic thymoma histology impact your decision regarding adjuvant radiation?
This is a good question. I honestly have never seen this histology, and I help write the UpToDate thymoma section and am a thymoma enthusiast (meaning I like to read about it/treat it, not to have it). Thymomas really run the spectrum of aggressiveness, and the approach to them in the adjuvant setti...