Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider definitive radiation to a medically inoperable patient with left sided early stage breast cancer?
I have had two unique circumstances where I have performed RT alone (with all the appropriate caveats/counseling). I performed an SBRT-type plan of 9 Gy x 5 delivered every other day. Clinically, the patient had a CR and radiologic imaging showed a continued decrease in size and ultimate stability 3...
Do you include the entire seroma in your lumpectomy cavity volume for PBI when it extends far beyond surgical clips?
Yes, as surgical clips can migrate and can’t ignore visible seroma which is part of the surgical bed.
What would your radiation field be for a 7.5 cm DLBCL involving the tibia (with pretibial soft tissue involvement) after CR to R-CHOP x6?
Modern radiation fields in this setting would follow principles of involved-site radiotherapy (Yahalom et al., PMID 25863750). In the context of combined-modality therapy, radiation therapy is directed at original sites of involvement only. In this case, I would utilize pre-chemotherapy imaging (PET...
How would you approach radiation treatment for a grade 3A follicular lymphoma that has recurred multiple times with one site of active disease?
Let me add a second question to the one asked – Is the patient in this clinical scenario curable with any type of therapy? Almost certainly not, although one would like to know more about the clinical course of events, what sites have been involved, over what period of time the relapses have occurre...
What treatment would you offer for a patient with prior primary prostate radiation, with a biochemical progression to PSA >1.0 and negative PSMA scan?
I’m assuming the patient has already received a prostatectomy and received prostate bed radiation, with a rising PSA. First, in terms of imaging, you may want to consider a contrasted pelvic MRI, which may reveal a small lesion in the prostate bed which may have been obscured by PET activity from t...
Do you recommend any PSMA PET agent over another?
PyL aka PYLARIFY (18F-DCFPyL) and 68GaPSMA-11 are the two agents commonly used on PSMA scanning in the US. Some have said PyL might be slightly better, however, even proponents admit only rarely with clinical significance. The intensity of the signal/uptake/SUV is usually higher with PyL than with ...
How do you approach a local failure with a rising PSA following prostate SBRT?
I would obtain an MRI if not already done to help delineate local disease extent. A variety of salvage options are available (RP; HIFU; cryotherapy; and re-irradiation with brachytherapy or focal SBRT). A recent systematic review and meta-analysis of local salvage therapies was published by a group ...
What would your radiation volume be for a patient with SCC just medial to the infraorbital foramen with positive PNI who presented with pain s/p regional excision?
Probably operative bed, 5-10 mm CTV into soft tissues, and the path of the V2 cranial nerve.
How do you approach radiotherapy after the patient has a facial nerve graft as result of tumor resection?
No differently.
When would you consider neoadjuvant RT for dermatofibrosacroma protuberans?
Same circumstance as when I would offer preop RT for a low grade STS: recurrent, anticipated close or positive margins, or local recurrence unlikely to be salvageable.