Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What would you include in the radiation field for a patient with T2 N0 M0 adenocarcinoma of the distal 1/3 of the esophagus?
I would the celiac axis in this patient. The morbidity of 50.4 Gy is low and the likelihood of occult nodal disease to the upper abdomen is high.
In a patient with local recurrence of breast cancer after mastectomy, how would you sequence adjuvant treatment after wide local resection?
Endocrine therapy can be given simultaneously with RT without increasing toxicity or decreasing effectiveness, as shown in a randomized French-Swiss trial (Azria et al., PMID 20138810). Toxicities from chemotherapy may be greater and its effectiveness reduced (at least for high-risk patients) when g...
Do you recommend neoadjuvant chemotherapy or induction chemo + chemoRT for borderline resectable pancreatic cancer?
The definition of BRPC has expanded to include everything from minimal venous involvement to 180 degree abutment of the SMA. It is important to determine if there is arterial involvement. If there is, the best data show that XRT helps with R0 resections. In our experience at MDACC, 95% of patients w...
What factors would make you strongly consider re-irradiation of the chest wall in a patient who has previously undergone whole breast irradiation?
For an in-breast tumor recurrence (IBTR) after BCS and breast (only) radiotherapy (assuming the patient undergoes mastectomy) I would offer re-irradiation for any indications I normally would for PMRT (node positivity, involvement of the skin, inflammatory recurrence, etc). It should be noted that w...
How would you manage a patient with new FDG avid retroperitoneal lymph nodes after completing definitive chemoradiation for stage III anal canal cancer?
I agree with @Dr. First Last. PA nodes are not really systemic disease if you consider the disease biology. They are regional nodes. There is 100% RR and >90% LC with chemoradiation with very low risk.
Would you offer adjuvant radiation for a sebaceous carcinoma of head and neck after wide local excision?
Yes and yes.
What margins (CTV and PTV) do you use for palliation when using Quad Shot regimen?
Since this is palliation and generally used for patients with limited longevity, there shouldn’t be a need for a CTV expansion for quad shot. You may use your typical location specific expansion, keeping in mind the particular needs of the patient - their ability to remain immobile and recreate a re...
What are the roles of whole brain radiotherapy and stereotactic radiosurgery for hemorrhagic brain metastases?
Most of the patients I see with brain metastases have primary lung cancer, so hemorrhagic brain metastases from primary choriocarcinoma is not something I see much. But I do see a few melanoma brain metastasis patients and hemorrhage in that situation is more common than in primary lung cancer. A fe...
Is it acceptable to give weekly cisplatin for patients with locally advanced head and neck SCC undergoing chemoradiation?
@Dr. First Last just presented at the ASCO H&N highlights session that weekly cisplatin 40mg/m2 is now considered a standard of care, at least in the post-op high risk setting based on data by Dr. Kiyota et al. showing superior outcomes, likely due to higher cumulative cisplatin dose (>200mg/m2) com...
How would you treat a patient with RP and salvage XRT now with a PET PSMA positive node?
The question is a bit unclear, but I will assume that this patient has already had RP and salvage RT to the prostate bed only and now presents with a PSA of 4 and the PSMA-PET is positive in the pelvic nodes. In this situation, I generally recommend long-term ADT plus RT to the pelvic nodes, but I w...