Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach a breast cancer with noninflammatory skin invasion (T4b)?
For a T4b breast cancer with limited skin involvement, BCT is an option. For adjuvant RT, I would consider bolus around the involved region for part of treatment. Bolus decision can be made based on final pathology and response to NACT (if treated with that approach). If the patient undergoes mastec...
When would you hold anticoagulation medications in patients undergoing a tandem and ovoid/ring?
We usually don’t hold unless planned for hybrid with needle placement. We would make sure sonogram is available for placement of tandem to avoid false track.
How would you approach residual ipsilateral diaphragmatic disease for M1a thymic cancer after induction chemotherapy and otherwise complete resection of primary and pleural disease?
I would favor surgical approach to resect it if the patient can tolerate it. RT could be considered but motion management is crucial. The data on second-line chemo is very limited.
Would you consider SBRT for node negative small cell carcinoma of the prostate?
There are no prospective data to guide the use of RT in the management of small cell carcinoma of the prostate. Retrospective data would suggest possible benefit at least in terms of control of disease in the prostate with the addition of local RT to systemic chemotherapy (see Oke et al., PMID 33824...
Would you offer upfront radiation for a large painful keloid of the chest that has arisen from an irritated pyoderma gangrenosum lesion?
Radiation therapy is actually used (rarely) for pyoderma gangrenosum that has been unresponsive to medical management via immunosuppression [1]. Single fraction doses of 400 to 800 cGy have been used with slow regression of the lesions. In the case report cited, the lesion started fading after 3 mon...
Do you consider clinically node negative patients who have been on neoadjuvant endocrine therapy eligible for omission of axillary dissection if their sentinel node is positive?
No good data and we have proceeded with regional nodal RT instead of ALND in these patients who are imaging negative and post endocrine SNLN node positive disease.
Would you offer RT for a nodal recurrence of NSCLC that has resolved radiographically after chemotherapy?
Nodal recurrences are bad. When addressing nodal disease that "disappears" after chemotherapy, I have modeled my decision making on the premise used in small cell lung cancer treatment where even in the face of CRs on imaging after chemotherapy, radiotherapy was always added to the mediastinal (noda...
Is extramural venous invasion (EMVI) alone an indication to treat rectal cancer patients with total neoadjuvant therapy as opposed to neoadjuvant chemoradiation therapy or short course radiation therapy alone?
EMVI detected on a staging pelvic MRI for rectal cancer has been shown to be a poor prognostic factor with an increased risk for distant metastases (Siddiqui et al., PMID 28449006). EMVI was also independently associated with a positive circumferential resection margin in low rectal tumors based on ...
What is the best way to approach adjuvant therapy for a FIGO Stage IIIB clear cell carcinoma of uterus s/p TAH BSO, with pathology showing extensive involvement of LUS, the cervix, and bilateral parametria with positive parametrial margins?
I wound get MRI imaging for pelvis to rule out gross disease and assuming staging is negative, would favor chemo RT to 50.4 Gy if not gross residual disease, followed by vaginal brachy boost and then additional chemo.
How would you manage a patient with PSA relapse 10 years after salvage radiotherapy with PSA doubling time<6 months?
Depending on PSA, would image with PSMA PET - typically, will do around PSA 0.5 or higher (given most insurances will not cover multiple PETs in a short timespan, and detection rates of ~50% at PSA 0.5-1 per CONDOR). If no targetable (by XRT) disease on that, would discuss ADT given increased risk o...