Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Will the recent publication of the MA.20 and EORTC 22922 studies in NEJM, showing no survival advantage from regional nodal irradiation in early-stage breast cancer patient following surgery, change your standard of care for these patients?
Two major landmark studies recently published simultaneously in the New England Journal of Medicine, Volume 373, 2015 (NCIC MA.20 study by Whelan et al. and the European Organization for Research and Treatment of Cancer (EORTC) 22922-10925 study by Poortmans et al.) will have a significant impact on...
In a patient with an N+ anal cancer on pre-treatment PET, should a PET scan be repeated in follow-up?
To answer the question directly asked, yes, I do. I find it to be valuable for treatment response, as outcome correlates with response. Personally, sometimes although test results may not be actionable (i.e. will not likely change immediate management), the "boost" a patient gets from knowing they a...
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 ...
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...