Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach a morbidly obese patient with early stage favorable breast cancer who is premenopausal?
Yes, if favorable phenotype, would do APBI.
What is the most efficient way to contour small and large bowel?
MIM has a very user friendly and I like airplane mode. In general, it can be sometimes difficult to determine small from large bowel but if there is air, it is usually a sign that it is large bowel and if it is only liquid, usually small bowel. The terminal ileum sometimes has air in it, and the col...
How would you treat a patient who is HIV+ with a p16+ SCC obturator node presumed to be T0N1 anal cancer?
Patients with SCCa unknown primary met to pelvic nodes are highly curable. We published 60% 5Y survival. You almost never find a primary, one almost never presents later without elective treatment. If it does, it is easy to salvage with radiation or surgery. Therefore, I do not recommend elective tr...
When would you consider a workup for C. diff in a patient with diarrhea under-going concurrent chemoradiotherapy for rectal cancer?
Good question – and hard to pinpoint a strict answer. I think any time the diarrhea is out of proportion to expectation (i.e., very early in RT course), clinically significant (dehydration, etc), and not controlled or responding to anti-diarrheal medications, especially in the setting of C. diff ris...
Would the presence of a close but negative pleomorphic LCIS surgical margin impact your decision for APBI in a patient who is otherwise a favorable candidate?
There are evolving data and ideas around pleomorphic LCIS with some consideration of treating it like DCIS (Savage et al., PMID 29894223; Desai et al., PMID 29947004).As such, I would consider this margin similar to a close DCIS margin. If there is invasive disease with this, I am fine with no tumor...
How do you boost patients with IVA cervical cancer who present with a large fistula that worsens during chemoradiation?
Preferred is interstitial brachy with our dose of 5.5 to 6 Gy x 5 in BID fractionation. Either MRI pre brachy with CT-based planning with applicator or MRI-based planning if can use hybrid applicator.
What is your recommended way of managing a locally advanced bulky base of tongue (BOT) p16 negative squamous cell carcinoma extending into multiple structures of the supraglottic larynx?
ChemoRT. We did pretty well with RT prior to HPV. Surgery is likely no better and more morbid.
How long to you wait after laparoscopic oophoropexy to deliver pelvic radiation?
I am not familiar with any data to guide an optimal interval between ovarian transposition and start of pelvic radiotherapy as it relates to impact on ovarian function, toxicity, or other end-point. As continued delays in radiotherapy may be associated with poorer oncologic outcomes, I have tried to...
What is your surveillance strategy in patients with brain metastases who are getting systemic therapy?
Generally, I’d consider a repeat MRI every 2-3 months, earlier if warranted. Assuming no evidence of disease progression for 1 or 2 years, I’d consider every 3-6 months.
Do you give adjuvant RT to vulva in a patients with node positive vulvar cancer and no high risk features for vulvar recurrence?
There is variation in practice. I tend to treat primary also along with nodal volume as long term data shows a 25- 35% risk of LR and a low 65% salvage rate. Data unknown is how much would RT reduce this and if these are true recurrences or new primary. Te Grootenhuis et al., PMID 26428940