Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When treating anal cancer with VMAT or IMRT, do you use bolus?
I bolus the primary if I can see it on inspection in the treatment position. I do not usually use bolus for the inguinals unless there has been an excision or the tumor is involving the skin. In that case, I give a 5cm margin on the scar with bolus. I have seen several cases in the distant past of d...
Are there any precautions you would take when radiating the pelvis in an obese patient with recent extensive ventral hernia repair to minimize dehiscence risk?
Have done few times. Contoured mesh area or open wound area as avoidance structure following ALARA principle.
Would you offer adjuvant radiation for a DFSP with fibrosarcomatous transformation s/p wide local excision?
DFSP is a locally aggressive tumor with a significant rate of local recurrence depending on treatment modalities (0-40%). The primary approach is wide local excision (usually 3 cm lateral margins) or Mohs' micrographic surgery. Rarely these tumors undergo a fibrosarcomatous transformation, and these...
Is there an optimal bridging radiation dose for aggressive B-cell NHL undergoing CAR T-cell therapy?
The perfect radiation dose for a given patient probably depends on a number of patient and disease-specific factors including tumor biology and genetics, the anatomy of the tumor and adjacent organs at risk, and the radiation technique used. We do not have the ability to recommend such individualize...
How do you decide what elective lymph node stations to include in your treatment volume for cervical and upper and middle thoracic esophagus cancer?
I hate to describe it this way. However, unless there is imaging evidence of specific nodal disease, the nodal coverage for esophageal cancer is mostly one of convenience (both for the patient and the physician). For distal lesions I like to cover the celiac axis and for proximal lesions I like to c...
How do you manage multiple cavernous malformations that have bled and enlarged over time?
Intracranial hemorrhage (ICH) is one of the most common manifestations of cerebral cavernous malformations (CCMs) occurring in about 25% of the cases. Two recent meta-analyses report a risk of 15% of ICH at 5 years. The treatment of these patients is very controversial. A recent population-based stu...
Is there a role for XRT in the treatment of epistaxis from hereditary hemorrhagic telangiectasia?
Here is a case report about its utility: Niyazi et al., PMID 20368796. I recently saw and plan to treat an elderly patient with a locally advanced cutaneous squamous cell carcinoma invading the nasal cartilage. I plan to give 60 Gy to the skin cancer and a lower dose to the nasal mucosa (perhaps 50 ...
How frequently do you observe transient enlargement of a vestibular schwannoma after SRS?
Transient enlargement of a vestibular schwannoma is not uncommon, and it's appropriate to reassure patients. I image these patients once every 6 months until radiographic stability, and then once yearly.
What is your preferred treatment for enlarging bilateral acoustic schwannomas?
This is indeed a very challenging situation, with no easy answers. A number of variables, such as patient age, hearing status, knowledge of sign language, expected longevity, underlying cardio-renal-GI conditions, genetic make-up (NF?), presence of other tumors, etc., would drive the decision making...
Would you consider radiation to the axillary lymph nodes ONLY (omitting chest wall) for patients with 1-3 axillary LNs who would otherwise not receive post-mastectomy radiation (T1-2, clear margins etc) when these patients have or will undergo breast reconstruction?
I am not a fan of this approach. In patients with node positive disease without a locally advanced primary, the majority of local-regional relapses are actually still on the chest wall. Perhaps there is rationale, but if I am to treat regional nodes, I would include the chest wall. I have occasional...