Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you ever treat patients with rectal or anal cancer with IMRT in the prone position?
I would favor treating most patients with rectal and anal cancer in the prone position, with a bowel exclusion device incorporated into the immobilization. The RTOG 0529 small bowel DVH data suggest that, even with IMRT, there is at least a trend favoring the prone position. In my own practice, the ...
Do you recommend resection for positive anterior or posterior margins in a patient s/p mastectomy if the surgeon says they took all the breast tissue anteriorly to the skin or posteriorly to the fascia?
It's hard to localize a margin positive area after mastectomy (unlike lumpectomy) and most of the time we dont recommend resection unless the area can be localized with certainty
How do you approach selection of dose and fractionation for definitive treatment of localized skin cancers?
I presume the question applies to non melanoma skin cancers, i.e. basal cell or squamous. These lesions were frequently treated with RT years ago before the advent of Mohs surgical techniques but are now seldom seen in RT departments. Too bad, because in my experience, relatively short courses of RT...
For patients with laryngeal cancer about to start chemoRT who have a narrow airway on imaging but are asymptomatic without any stridor or shortness of breath, do you take any precautions to prevent airway obstruction secondary to radiation-induced edema?
I base my decision on my endoscopy. I feel it's important that radiation oncologists treating head and neck cancer perform their own endoscopy to assess the tumor extent and airway. Imaging (ie CT) can be deceiving depending on cough/clearing throat/holding breath at the time of scan. Converse with ...
Is a completion axillary dissection required for a patient with clinical N+ disease who had a complete clinical response in the axilla to neoadjuvant systemic therapy but is found to ypN+ disease on sentinel node biopsy?
Only a few published studies present sufficiently detailed subgroup data to determine rates of axillary failure or total regional nodal failure for patients having sentinel node biopsy (SNB) after neoadjuvant chemotherapy (NACT) after finding either isolated tumor cells (ITC), micrometastases, or ma...
What size cut-off do you suggest for the safe administration of SRS in the setting of brain metastases?
The likelihood of radiation necrosis or acute treatment related imaging change does seem to increase with larger lesion size. I get worried once the target approaches 3 cm in diameter but have treated selected patients beyond that out to 4 cm using 15 - 16 Gy. We have an ongoing trial of dose select...
How do you counsel patients with NF1 diagnosed with breast cancer regarding breast radiation?
These patients tend to present with more aggressive breast cancers (higher grade and stage, and higher incidence of contralateral disease). They are also thought to be at increased risk of radiation-induced malignancy (including sarcomatous changes). In addition, screening and surveillance are chall...
Would you offer consolidative radiotherapy for oligometastatic NSCLC?
These are extremely challenging cases and the recent negative studies have somewhat dampened my enthusiasm. It has been challenging, in general, to obtain authorization for treatment in these cases and the release of this data will not make it any easier. And as experts note, there are multiple bin...
Would you offer a patient with “good-risk” DCIS and an elevated DCISionRT score APBI or WBI?
Based on the technical suitability, either option is fine.
How do you manage a glioblastoma of the brainstem/upper cervical spinal cord?
It used to be that we didn’t get biopsies in this location, and we treated suspected astrocytic tumors in the brainstem/upper spinal cord to 54 Gy in 30 fractions without tissue. The outcome was never good. But now we generally have at least a stereotactic biopsy. The outcome is still not good of co...