Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you use traditional bony landmarks or contoured nodal volumes when designing breast and supraclavicular treatment fields?
The classic field borders and blocks that I was trained with in the 2-dimensional era, result in almost the same field as those achieved by laboriously contouring the nodal volumes and expanding them. That is a testimony to our predecessors’ knowledge of anatomy, clinical examination of patients wit...
What volume would you treat with radiation in the setting of high risk oral tongue cancer completely resected with surgery and negative bilateral neck dissections?
Despite negative margins and pN0, the risk of LRR in this pT4 patient is high, regardless of whether or not the number of dissected nodes was adequate. Moreover, the chance of surgical salvage if recurrence happens in a previously dissected neck is small, as such recurrent tumors tend to encompass t...
For head and neck cancer radiation requiring boost, do you plan using simultaneous integrated boost technique vs cone down technique?
SIB always provides more conformal dose distributions compared with sequential boost IMRT, as the beam placement and intensity of the sequential boost do not take into account the dose distributions of the first plan. This issue, as well as the lower fraction doses to the normal tissue embedded in t...
How do you approach patients with osteosarcoma of the maxilla for neoadjuvant chemotherapy?
The SOC treatment for “jaw” OS is a margin negative surgical resection. If indeed feasible (not always the case), this applies to maxillary tumors. Jaw OS does respond poorly to standard chemotherapy. In our experience, HD Ifosfamide may be a better choice than standard Dox/CDDP. We use this approac...
Is there an age cutoff at which you would recommend against radiosurgery for a schwannoma or trigeminal neuralgia in someone who is a good surgical candidate with no comorbidities?
Personally, I do not have a specific age cutoff, but do have a careful discussion about secondary malignancy risks in a younger patient. With younger patients with schwannomas, one has to be careful about neurofibromatosis as there may be a higher risk of secondary malignancies from radiation. With ...
Do you consider multiple sclerosis a contraindication for SRS?
The answer to this question in my opinion is in two parts :1. Looking at the data in detail from this paper:a. Three of the 6 patients with MS had brain mets and recieved the higher doses - and had no complications.b. The one patient with a facial schwannoma developed facial palsy - which is not unu...
What group of patients is suitable for breast radiation using high tangents?
I could consider high tangents for patients with ER+ disease and N1mic. If patients have ER- and N1mic or N1 disease with macromets, I tend to add RNI.
How would you post-operatively manage a peripheral stage I small cell lung carcinoma s/p upfront wedge resection with an R1 microscopic positive margin along the staple line and visceral pleural invasion?
I would advise 4 cycles of chemotherapy followed by immunotherapy. It would be hard to define a “reasonable radiotherapy target” with visceral pleural involvement and surgical suture line, which is true in NSCLC as well. I would not recommend thoracic or prophylactic cranial radiotherapy.
Is there data, or even anecdotal reports, of cosmesis or capsular contracture of a previously augmented breast after lumpectomy and hypofractionated whole breast radiation?
So, you will probably encounter more people who admit to being abducted by UFOs than using HFRT in someone with a cosmetic or reconstructed implant. I've even heard people argue that they go at 1.8Gy/fx as opposed to 2Gy "just to be on the safe side" with regard to capsular contracture. The fact of ...
In the era of neoadjuvant chemotherapy, how reliable is biopsy for assessment of LVI to make decisions about PMRT?
If bx is negative for LVI and final path is negative after NACT, then would not speculate about the possibility of LVI as risk factor for PMRT decisions.