Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Under what circumstances would brachytherapy be preferred over electron therapy for treating skin cancers?
For small (<2 cm) nonmelanoma skin cancers, I would say that brachytherapy is preferred for these reasons: Better cosmesis - 90-95% report excellent, which is better than electron series, particularly at the edge. Better for curved surfaces like the nose b/c applicator is flush on the skin with no ...
Would you recommend adjuvant radiation therapy to the locoregional lymph node basins for Merkel cell carcinoma (MCC) s/p WLE with negative margins and isolated tumor cells in 1 of 3 right inguinal sentinel lymph nodes?
Yes, this is not an easy disease to cure in the node-positive setting. So, the question can be framed: do isolated tumor cells constitute a benign finding, frank malignancy, or a space in between? I don't have an answer to that, and perhaps given the rarity of the entity, that answer will remain rec...
How is your approach to a patient referred for radiotherapy for keloids with a history of Beals syndrome?
Although of theoretical concern, I am not aware of any contraindication to RT (treatment philosophy similar to Ehlers-Danlos syndrome).
Does pleural tenting adjacent to tumor impact your target volume for early stage NSCLC planned for SBRT?
Having reviewed the images in the cited paper, the question of how to define the target for tumors with proximity to the chest wall and that also show pleural tenting is one that my thoracic radiation oncology colleague will often discuss. The brief answer is that although tenting likely represents ...
For a patient with glioblastoma also found to have a distant presumed meningioma with a location/size such that you would have otherwise recommended RT, would you offer concurrent treatment?
I think if the situation is non-urgent and the lesion (meningioma) can be safely monitored, one approach would be to prioritize treatment of the glioblastoma while observing the meningioma. If, however, the meningioma demonstrates interval growth and/or is located in an area at higher risk for causi...
How do you determine the timeline for healing after craniotomy prior to starting chemotherapy and radiation?
I typically wait at least 10-14 days post-op, always after neurosurgery has re-evaluated the craniotomy site for appropriate healing and has already removed staples or sutures.
What is your radiotherapy plan for recurrent midline epidermoid cyst after resection around 10 months ago?
Radiotherapy for suprasellar epidermoid cysts is typically reserved for rare, recurrent, or malignant cases where surgical resection is not feasible. While microsurgical removal is the standard, adjuvant radiotherapy (conventional or stereotactic/Gamma Knife) can effectively manage residual or recur...
What radiation dose and margins would you recommend for treatment of a progressive cerebellar glioma with BCOR/BCOR1 fusion after initial subtotal resection with residual disease adjacent to the posterior brainstem?
BCOR fusion glioma is a rare type of brain tumor, often seen in children and young adults, characterized by gene fusions involving the BCOR (BCL6 corepressor) gene with partners like EP300 or CREBBP, leading to unique molecular and histological features, presenting as high-grade neuroepithelial tumo...
How would you advise a younger patient with residual/recurrent optic nerve meningioma, proceeding with radiotherapy, about the risks of malignant transformation or induction of other brain malignancies because of radiation?
The risk of malignant transformation of an optic nerve sheath meningioma (ONSM) after RT appears to be remarkably low, much lower than the risk of blindness from an untreated, progressive ONSM. In a younger patient, I would lean toward RT for patients with imaging progression or early visual loss, ...
What would be your radiotherapy plan for a patient with recurrent GBM (WHO grade 4, IDH wild-type) s/p 2 prior resections with no prior radiation?
The scenario described in this clinical case is not uncommon. I have had patients who either live several hours away from our center or were unwilling to receive the Stupp protocol of 60 Gy in 6 weeks and were successfully treated with 3 weeks of hypofractionated RT (HFRT). HFRT over 1–3 weeks (25 G...