Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a scalp squamous cell carcinoma s/p Mohs with high risk features who underwent placental grafting to expedite the healing process?
When the plastic surgeon says it is safe to deliver radiotherapy, proceed.Clearly, the primary method used here in this case was surgery, so those physicians carry the water. What should be avoided is the situation where the skull becomes exposed, so the graft's health is important. Various systemic...
Would you offer ultrahypofractionated 5-fraction whole breast only for a women with ER-/HER2+/cN+ disease with pCR following neoadjuvant systemic therapy?
If the plan is to treat breast only then 26 Gy in 5 with and without boost is fine. The philosophy of treating RNI would vary based on the interpretation of 5 years of B-51 data.
How do you prevent and treat lymphedema following head and neck XRT?
I have had success over many years using sodium selenite 250 mcg, 2 capsules daily, for patients with subacute supraglottic edema after head/neck radiotherapy. The majority of patients report a moderate improvement in symptoms of raspy voice and mild dysphagia. This is clearly not appropriate to man...
How would you determine ipsilateral vs bilateral neck irradiation for early stage, well lateralized nasal cavity SCC?
In general, anterior nasal cavity tumors drain to level IB through the facial nodes and to level II, while posterior cancers drain to level II as well as retropharyngeal (VIIA) and retrostyloid (VIIB) nodes through the nasopharynx. Whether there is a difference in contralateral risk for well-lateral...
Would you offer elective RT for an early stage, high grade penile cancer sp partial penectomy who cannot undergo groin sampling/SN biopsy?
The guidelines for adjuvant treatment of penile cancers are all over the place because of lack of any good data (rarity of disease). We have extrapolated from vulvar ca and considered adjuvant RT treatment with similar philosophy. (Prophylaxis to bilateral groin for microscopic disease, if surgical ...
Is stage I B/L breast, ER+ cancer a contraindication to breast radiation omission after breast conservation surgery?
There is no contradiction as long as each lesion meets the omission criteria
What, if any, cardioprotective measures beyond dexrazoxane may be used to minimize cardiac risk during or after chemo- or radio-therapy?
For cardioprotection, I would recommend: Baseline cardiovascular risk stratification, can use the HFA-ICOS risk calculator (https://www.cancercalc.com/hfa-icos_cardio_oncology_risk_assessment.php), consider alternative chemotherapies if very high risk and alternative therapy equal efficacy. Optimiz...
Would you treat the pelvis electively while treating the prostate in a setting of low volume metastatic prostate cancer?
I think it depends on how low volume the metastatic disease is, and how it was detected. A tiny bone met that was only detected through a PSMA scan in a patient with otherwise negative conventional imaging would likely be different than someone with 5-10 bone mets discovered on a bone scan. We've li...
What is your approach to a tumor bed boost in early stage breast cancer patients with micrometastasis?
Micrometastases are not specifically associated with increased IBTR. I would use whatever algorithm you typically use to determine whether or not you boost.
Are weekly port films or daily cone beams considered standard of care for 3D breast treatment?
It doesn't have to be either/or. But...As Don Rumsfeld said, "You go to war with the army you have, not the army you want." Some practices, and they are rare admittedly (think: a site with only a Tomotherapy machine) can't really do "port films" per se and they're wont to do daily IGRT/CBCT. If "MRI...