Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In clinically node positive vulvar cancer, are you recommending bilateral inguinal LND or nodal debulking followed by adjuvant radiotherapy?
I am sure there is wide variation in practice as there is no prospective study to guide care. Our approach is definitive chemo RT with the removal of only residual persistent node. Richman et al., PMID 32981696
When contouring locally advanced NSCLC, how do you define your ITV if your iGTV overlaps with an OAR?
For locally advanced lung, I have 2 slightly different approaches for primary vs nodes. For primary, GTV to iGTV (with 4DCT or DIBH scans x 3 at sim in certain cases) to CTV (5 mm expansion cropped to anatomical barriers to spread) to PTV (5 mm uniform expansion). I let the iGTV overlap the esophagu...
What is the appropriate treatment for marginal zone lymphoma of the parotid following surgery?
Definitive radiation therapy is the standard treatment for a patient with an uncomplicated case of localized marginal zone lymphoma of the parotid gland. The CTV would encompass the entire gland and the total dose would be 24 Gy. Occasionally patients will be diagnosed with MZL after parotidectomy, ...
How would you alter your treatment volumes in a patient with distal esophageal cancer who has had prior gastric bypass surgery?
Some additional context would help in answering this question. For example, is this patient a surgical candidate and is the intent of radiation as part of preoperative treatment, or is this definitive therapy in an unresectable patient? Also, what is the concern that is leading to the question? Is i...
Would you consider palliative radiation for a bone metastasis while patient is on pembrolizumab and axinitib?
If the dose to the hollow organs (in this case, the esophagus) is low, it should be OK to give axitinib (with anti-angiogenetic property) concurrently with RT. If the amount of lung exposed to radiation is small, it should be safe to give pembro (risk of pneumonitis) together. The above comments are...
What is the role of MRI in target delineation of radiation therapy for non-NPC H&N cancers?
I don't think MRI is necessary for most OPCs. I do use MRI in some cases, such as 1) patients being considered for surgery first (to determine if endophytic tumor is better suited for RT), 2) whenever I have clinical concern for perineural spread, and 3) to further assess deep invasion or involvemen...
Is there an indication for bolus in whole breast RT for early-stage invasive ductal carcinoma with micropapillary features?
I have not and would not suggest changing RT management based on histology alone unless dermal lymphatics invasion was seen on pathology.
How would you approach adjuvant therapy for a patient with pT2N2 lung adenocarcinoma who underwent an R1 resection and is not amenable to further surgical intervention?
I don't know that I have a trial (much less a randomized one) to prove this, however in this situation, assuming the patient has adequate functional status and has recovered sufficiently from surgery, I would treat the surgery as an extended biopsy. I.e., I would probably (with my radiation colleagu...
Are there best practices or data regarding the use of open notes among oncology patients?
The 21st Century Cures Act regulation (effective April 2021) required that clinical notes such as consult and office notes be shared with patients, e.g. “open notes.” In general, surveys of patients with cancer and their clinicians suggest that open notes are viewed favorably (Salmi et al., PMID 330...
How would you treat prostate cancer that recurs after radical prostatectomy with invasion into bladder, rectum and musculature?
In a case with extensive disease like this, I would first restage ideally with a molecular study like PSMA to ensure no evidence of metastatic disease. In the absence of metastatic disease, I would recommend starting with ADT (+/- abiraterone or other novel anti-androgen) to downsize disease away fr...