Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
If a patient has a mediport within the radiation field, will you insist the patient have it removed prior to radiation?
I do not move ports from the chest wall normally out of the way during usual photon radiation fields even if they are on the same side as a breast or chest wall I am treating. I have treated them in a tangent or a supraclavicular photon field without any apparent problems. But it could cause a theor...
Would you re-irradiate the axilla after a resection for an isolated axilla recurrence in a breast cancer patient who had prior radiation to the breast and axilla?
I have, in the past, treated resected axilla recurrence with matted nodes/ECE where local recurrence risk was high and there was only partial overlap with the prior fields treated a few years prior. In those cases, I will include previously non-radiated nodal areas but not the breast/chest wall if i...
What volume would you treat for an isolated axillary recurrence after BCS and whole breast RT who have resection of the recurrent disease?
In the case of prior whole breast (or chest wall only) radiation, I would typically only treat the nodal region after a isolated regional recurrence. The target volume should include at least the undissected axilla and infra/supraclavicular stations. I have not treated the IMNs after an isolated axi...
Is there a firm rib dose constraint when treating lung tumors abutting the visceral pleura/chest wall with SBRT?
While I am concerned about chestwall pain and rib fractures, I am usually reluctant to alter my volume or dose. At the Radium Society Meeting in 2013, Ben Slotman released data on local recurrences after SBRT, and he found a 3 year recurrence rate of ~8%. More interestingly, he found that 56% of the...
What doses and volumes do you use in treatment of rectal cancer post-operatively?
A surgeon I once worked with used to say "Post-op RT is a disease". I can't remember the last time I treated someone with rectal ca post-op. When we recommend surgery first without pre-op, it is with the understanding, that will not be don't post-op regardless of the pathology. However, here are so...
How do you manage high grade dysplasia of true vocal cord a yr after radiation to the larynx for T1 lesion?
Transoral excision.
What approach do you use when treating adult diffuse gliomas with H3-G34 mutations, now classified into their own category under the 2021 glioma guidelines?
Although DHG H3G34-mutant diffuse gliomas are more commonly associated with pediatric patients, they can occur in young adults as well. In a recent paper describing 17 patients harboring this rare mutation, the median age at diagnosis was 25 years (range: 19–33). All tumors were hemispheric. All cas...
Would you offer consolidative scrotal RT for patients with bilateral testicular lymphoma involvement s/p bilateral orchiectomy and chemotherapy?
I assume you are referring to bilateral scrotal involvement by DLBCL. The initial stage of the disease is also not clear. If both testes have been removed, the risk of involvement with the scrotal sac may be assumed low. However, I would take a good look at the pathology report concerning extratesti...
How would you approach treatment of a patient with adenocarcinoma of unknown primary only found in a left supraclavicular lymph node?
Systemic therapy. Palliative RT if necessary
How do you approach stereotactic radiosurgery for acoustic neuroma in patients who are awaiting cochlear implant?
Defer to the otologist. You could SRS before or after unless the otologist has a strong preference. As long as the cochlear implant is MR-compatible.