Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you include the entire hardware as part of ISRT for a patient with Stage IE DLBCL of the distal femur treated with upfront prophylactic nailing for impending fracture, who had a CR to chemotherapy?
Quite uncommon to encounter such a patient, but based on data for non hematologic tumors, no. Treat just the involved site with a generous margin, the latter never precisely defined, but depends on the tolerance of surrounding normal tissue. Parenthetically, it's often difficult to determine a CR to...
Is it appropriate to offer combination lung SBRT and immunotherapy for oligometastatic melanoma outside of a clinical trial?
What is the anticipated recovery of bone marrow hematopoiesis after palliative radiation therapy?
What dose and fractionation do you use to palliate mycosis fungoides lesions?
I will admit that I utilize a wide range of fractionation schedules, depending on the clinical circumstances when treating mycosis fungoides. The data suggests that 2 Gy x2 is not an effective palliative schedule, with a CR rate of only ~30% with almost all lesions requiring re-treatment (Neelis et ...
Would you offer dose reduction to 36 Gy pre-op to a lower extremity low grade myxoid liposarcoma based on results of the DOREMY non-randomized data?
This is a great question. In consultation, I start discussing standard preoperative RT over 5 weeks, but then review the nuances of myxoid liposarcomas (e.g., radiosensitivity). We had a thoughtful discussion about the DOREMY study, including the de-intensification radiotherapy approach, results, an...
Which targeted systemic agents should be held while delivering palliative radiation?
Great question regarding the use of systemic therapy for cancer during palliative radiation. First, regarding targeted therapies, there are no reports of targeted therapies which would be unsafe or should be held during palliative radiotherapy. Most targeted agents are monoclonal antibodies to recep...
Would you go back and do an axillary lymph node dissection if a sentinel lymph node biopsy showed a single lymph node with extracapsular extension?
For microscopic ECE, would manage with comprehensive RNI but if gross ECE, would favor dissection and then RT.
Would you recommend axillary dissection for a patient with cT1N1 triple negative metaplastic breast cancer?
Although these cancers are underrepresented in SNLN and RT studies, we treat with the same principle like any other breast cancer with SNLN bx. Gebhardt et al., PMID 30197938
Would you recommend decreasing dose to the whole breast and nodes if constraints cannot be met?
For breast would not decrease dose but would block area of breast if feel risk of microscopic disease low to achieve normal tissue dosimetry For prophylactic treatment of IM node have decreased dose to 40 gy for coverage or even excluded them if lung and heart dose a concern
Do your radiation treatment margins change for cutaneous basal cell carcinoma in the adjuvant setting compared to cutaneous squamous cell carcinoma?
1 cm with orthovoltage, 2 cm with electrons collimated on the skin.