Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is an acceptable distance between tumor and heart or aorta to treat a non-small cell lung cancer with SBRT?
I will echo @Dr. First Last's answer. Having used 50 Gy in 5 fractions now for over 10 years at the Cleveland Clinic, we have not identified cardiac or great vessel specific toxicities for the close to 400 patients we have treated with this schedule. Specifically in compiling our data registry, we h...
How would you approach a 2 cm malignant primary cutaneous adnexal adenocarcinoma of the axilla s/p resection with positive margin who is unable to undergo additional surgery?
I would consider imaging of the regional node basin (axilla) first. If there was evidence of regional lymph node metastasis, I would image the body to evaluate for distant metastases. If there was distant metastasis, I would probably refer for systemic therapy. If there was no distant metastasis, ...
In a patient with an N+ anal cancer on pre-treatment PET, should a PET scan be repeated in follow-up?
To answer the question directly asked, yes, I do. I find it to be valuable for treatment response, as outcome correlates with response. Personally, sometimes although test results may not be actionable (i.e. will not likely change immediate management), the "boost" a patient gets from knowing they a...
When treating anal cancer with VMAT or IMRT, do you use bolus?
I bolus the primary if I can see it on inspection in the treatment position. I do not usually use bolus for the inguinals unless there has been an excision or the tumor is involving the skin. In that case, I give a 5cm margin on the scar with bolus. I have seen several cases in the distant past of d...
Are there any precautions you would take when radiating the pelvis in an obese patient with recent extensive ventral hernia repair to minimize dehiscence risk?
Have done few times. Contoured mesh area or open wound area as avoidance structure following ALARA principle.
Would you offer adjuvant radiation for a DFSP with fibrosarcomatous transformation s/p wide local excision?
DFSP is a locally aggressive tumor with a significant rate of local recurrence depending on treatment modalities (0-40%). The primary approach is wide local excision (usually 3 cm lateral margins) or Mohs' micrographic surgery. Rarely these tumors undergo a fibrosarcomatous transformation, and these...
Is there an optimal bridging radiation dose for aggressive B-cell NHL undergoing CAR T-cell therapy?
The perfect radiation dose for a given patient probably depends on a number of patient and disease-specific factors including tumor biology and genetics, the anatomy of the tumor and adjacent organs at risk, and the radiation technique used. We do not have the ability to recommend such individualize...
How do you decide what elective lymph node stations to include in your treatment volume for cervical and upper and middle thoracic esophagus cancer?
I hate to describe it this way. However, unless there is imaging evidence of specific nodal disease, the nodal coverage for esophageal cancer is mostly one of convenience (both for the patient and the physician). For distal lesions I like to cover the celiac axis and for proximal lesions I like to c...
How do you manage multiple cavernous malformations that have bled and enlarged over time?
Intracranial hemorrhage (ICH) is one of the most common manifestations of cerebral cavernous malformations (CCMs) occurring in about 25% of the cases. Two recent meta-analyses report a risk of 15% of ICH at 5 years. The treatment of these patients is very controversial. A recent population-based stu...
Is there a role for XRT in the treatment of epistaxis from hereditary hemorrhagic telangiectasia?
Here is a case report about its utility: Niyazi et al., PMID 20368796. I recently saw and plan to treat an elderly patient with a locally advanced cutaneous squamous cell carcinoma invading the nasal cartilage. I plan to give 60 Gy to the skin cancer and a lower dose to the nasal mucosa (perhaps 50 ...