Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there any trials currently studying low-dose RT for confirmed COVID-19 infections with associated pneumonia?
This is a joint reply from a team developing a prospective trial to answer this question:Minesh Mehta, Arnab Chakravarti, Walter Curran Jr, James Fontanesi, Vinai Gondi, Michael Kasper, Deepak Khuntia, Rupesh Kotecha, Ramesh Rengan, Leland Rogers, Charles B. Simone II, James Welsh, George WilsonThis...
How do you manage vaginal necrosis after pelvic radiation?
This is a broad topic that doesn't lend itself to a short answer format; however, I will offer a few thoughts. The first thing, of course, is to keep it from happening through judicious RT technique. Vaginal necrosis is most likely due to brachytherapy administration rather than external beam RT, an...
When is radiation indicated in the treatment of perianal paget's disease?
Extramammary Pagets disease is essentially adenocarcinoma in-situ and typically managed surgically. I would not treat with radiation unless it is invasive. If it is invasive and inoperable or if it would require APR, radiation is an excellent option. I treat them like SCCa of the anal canal, except ...
How would you treat a late local recurrence of extramammary Paget's disease of the vulva, not amenable to resection?
If the patient does not have any invasive disease, or underlying malignancy or nodes, then I would consider treating this with radiation, specifically superficial brachytherapy. At our institution, we routinely treat similar patients with large perineal, inguinal EMPD patients with 3D custom printed...
What radiation dose/fractionation would you consider for palliation of an unresectable vulvar cancer that received previous definitive radiation therapy?
For patients with recurrence after definitive vulvar irradiation, surgery is the best option, if possible.If this is not possible, then the retreatment with radiation can only be palliative to reduce pain or bleeding. Depending upon the extent of recurrent disease - a dose of 3000cgy in 10 fractions...
How would you approach a patient with a 12 mm recurrence of the left implant-based breast reconstruction 17 years after her initial diagnosis?
You haven't indicated what prior Rx the patient has received. Assuming no prior RT, I would radiate the chest wall, probably skip the nodes, and add hormonal therapy again, depending on what she has received in the past.
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
I find the biggest gains come from having clear and consistent communication around patient identification and treatment planning. Aligning on what constitutes “high risk” — both for local recurrence and metastasis — and which patients truly fall into the very-high-risk category is essential. It’s c...
What is your recommendation for patients who are on weight loss medications like GLP-1-based therapies while receiving chemoradiation for head and neck cancer?
I recommend immediate discontinuation of GLP-1-based therapies. Increased risk of nausea/vomiting and weight loss certainly aren't side effects we need during head and neck chemorads. Additionally, there is concern that these agents, even outside of cancer patients, contribute to sarcopenia, which h...
Is PMRT considered the standard of care in women with 1-3 positive axillary lymph nodes?
I come to this question with a somewhat different stance than we have traditionally thought. To me, the following things seem clear:1) In our modern randomized trials of PMRT (British Columbia and Danish 82b and c) there was no difference in the OS advantage of RT based on # of positive nodes (1-3 v...
Is it appropriate to consider ultra-hypofractionation for phyllodes tumors of the breast when adjuvant radiotherapy is indicated?
I have used moderate hypofractionation for patients with phyllodes tumors for whom the logistics of coming for conventional fractionation were too great. However, I agree with Dr. @Dr. First Last that there are no data yet supporting this for phyllodes tumors specifically. Further, the issue of whet...