Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider radiating an unresectable intimal sarcoma if it involved the valves of the great vessels?
First, I would quickly confirm that the patient is truly unresectable. I've seen complex cases deemed unresectable and therefore palliative at very fine institutions that were subsequently treated definitively after a second opinion at a center of peak surgical expertise. It is worth recognizing tha...
Would you recommend sentinel lymph node biopsy at the time of wide excision for a 3 mm Merkel cell carcinoma of the cheek/lateral canthus?
Unlike melanoma and certainly NMSC, MCC is highly unpredictable in nature, with clinical lesion size having little clinical prognostic value. As such, it appears that SLNB is valuable in many cases for the purposes of prognosis and in determining the need for adjuvant systemic therapy and radiation....
What are fractionation options for a patient with progressive jugular foramen paraganglioma now causing multiple cranial nerve deficits?
I typically individualize fractionation based on tumor volume, proximity to brainstem and cochlea/IAC (especially when serviceable hearing is present), and the pattern of cranial nerve deficits. For tumors <35 cc, I favor SBRT 24 Gy in 3 fractions, with escalation to 27 Gy when aiming for maximal tu...
What is your radiotherapy plan for stage IVA (cT4) cervical SCC with the tumor completely obliterating the bladder trigone?
I would follow the same schedule. After concurrent chemo RT, I would use HDR brachy with a hybrid applicator to achieve a D90 of 85 Gy or above to the HR-CTV and avoid any hotspot in the bladder wall. Part of the bladder wall in the trigone area receives a therapeutic dose.
In ES-SCLC presenting with limited asymptomatic brain metastases and treated upfront with systemic therapy alone (carbo/etop/atezo), how would you approach the brain if MRI shows PR after a few cycles?
In our practice, we would typically watch such a patient on systemic therapy. However, we would stress the need for vigilant monitoring and likely administration of RT (SRS ideally) at the carbo/etop/atezo transition to atezo monotherapy, given the poor intracranial efficacy of the maintenance syste...
How do you manage a cytology-negative pleural effusion that develops after lung RT?
I think most times you can just watch them as long as they are stable and not symptomatic. I see them not infrequently after RT, especially lung SBRT, and find they often find a size they feel comfortable with and don't change much over time. I wonder about their physiology... my impression is there...
Would you offer local radiotherapy to prostate in a patient with small cell neuroendocrine carcinoma who had a complete response to chemotherapy?
Thank you for this great question. Yes, I would strongly consider radiation therapy to the prostate and pelvic LNs for small cell carcinoma of the prostate. Small cell carcinomas of the prostate are rare and comprise <1% of all prostate cancers and are known to be more aggressive. They are often unr...
How would you approach a patient with vitreoretinal lymphoma without CNS or systemic involvement?
The optimal treatment approach for primary intraocular lymphoma is debated. This is a rare disease with only small retrospective series guiding therapy. There is no clear superior treatment approach in the literature. In clinical practice, younger patients are often treated initially with high-dose ...
How should you manage a coronavirus infected/suspected patient who is receiving radiotherapy and cannot interrupt or delay their cancer treatment?
Hi Everyone, I agree with all the comments—this is certainly a fluid situation. We have not had a confirmed COVID-19 case, but we have developed a plan. If it is deemed a known COVID-19 patient, and it is elected to continue treatment by the treating physician, the treatment will happen at the end o...
If adjuvant radiation is offered to an elderly patient with H&N SCC s/p Mohs surgery who is planned for multi-stage reconstruction of the defect with plastic surgery, when should adjuvant radiation be started?
Tumor control comes first. If the surgical defect is such that reconstruction is required, it is even more imperative to focus on the above principle, as a recurrence would almost certainly risk ruining the entire collective effort. Vascular flaps could be safely performed post-RT in most cases by s...