Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of SBRT in recurrent oligometastatic ovarian cancer?
Ovarian granulosa cell tumor are not as chemo sensitive and respond more to local treatment and have long disease free interval and longer time to recur. Surgery where feasible and if not local treatment with fractionated IMRT or SBRT is reasonable based on location and extent of disease to prolong ...
Would you recommend ALND or sentinel node re-mapping in a patient with recurrent breast cancer of the areola complex who had previous nipple-sparing mastectomy and SLNB and no previous radiation?
The extent of axillary surgery in general, and also in the setting of locally recurrent disease with a clinically-negative axilla, has lessened over time, largely to try to mitigate arm morbidity. In the past, if a patient had a prior SLNB at the time of the original diagnosis, it was not uncommon t...
What target volumes and expansions would you use for neoadjuvant chemoradiotherapy to a large thymoma with the goal of shrinking the tumor to aid resectability?
Achieving an R0 resection is an important prognostic factor in thymoma. If there is concern that an R0 resection may not be realized, typically due to the proximity of the disease to the great vessels, then neoadjuvant therapy is often recommended.At our institution, we universally recommend neoadju...
What is your approach to definitive radiation for p16+, cT2N1M0 (AJCC 8th ed) base of tongue SCC?
If there are multiple ipsilateral LNs, then I recommend CCRT with cisplatin. 70 Gy in 35 fractions via IMRT/VMAT. If only a single LN, I would likely recommend the same (especially if a large LN) if the patient could tolerate it, though RT alone is reasonable. If RT alone, then I typically accelerat...
What is the earliest you would start postmastectomy radiation after adjuvant chemotherapy for a patient with breast cancer?
Depends on the chemo regimen. If on 3/4 weekly chemo then wait for 3-4 weeks before starting RT but if on weekly chemo (taxol), then have done sooner also.
Would you offer nodal RT for pT2N0 triple negative breast cancer s/p BCS?
I agree with above and generally haven't routinely offered RNI for such patients. However, I consider making an exception in the setting of a tumor with multiple risk factors, such as medial location, young age, large T2, poor response to neo-adjuvant chemotherapy (so cT2N0, ypT2N0) with LVI, etc.
What region would you treat in a patient with high grade leiomyosarcoma localized to the spermatic cord with close margins (<1mm) s/p inguinal orchiectomy?
I would refer you to the excellent answers on this topic from a previous query on theMednet: https://www.themednet.org/question/5712 I see in your case there was a close margin - I would add that it's important to know if the margin was close at the longitudinal aspect of the resection along the spe...
How would you deliver salvage prostate bed radiation in a patient with a neobladder?
In a situation like this, I think the risks of an adverse event are higher and the chance of cure lower than the average patient. Thus, the anticipated behavior of the cancer will play a strong role in the decision about whether to treat or not. Factors like the Gleason score, risk factors for a rec...
Would you start any treatment for radiation pneumonitis if there is a large area of consolidation in the irradiated lung field but the patient is asymptomatic?
If the timeline matches then for radio graphic only pneumonitis, I would favor observation with a repeat scan in a few months.
Is there a role for nintedanib in the management of patients with radiation-induced pulmonary fibrosis?
There is no phase III evidence I am aware of on the benefits of nintedanib in the prevention of radiation-induced pulmonary fibrosis so it is not a drug I use. There are a few case reports and some pre-clinical studies suggesting an effect. There is a small (34 patients) randomized phase II study th...