Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you use CT planning to treat a large keloid of the scalp post operatively?
We use a CT sim for almost all keloids, especially those where complex planning may be needed.Depending on the size and shape, you can even consider more complex treatment approaches, as noted in this case report: Ilori et al., PMID 35755175.
How would you approach the treatment of low grade, stage IA, triple negative apocrine adenocarcinoma of the breast in a female patient in her 70s?
I would not treat this the way I would a typical triple-negative breast cancer, since the risk of distant recurrence from occult metastatic disease is low. Assuming she had breast-conserving surgery, radiation, favoring partial breast, is reasonable. In terms of systemic therapy, if the cancer in th...
How would you manage BCC to the left cheek after only half of a radiation course was completed three months ago and non-operative management is preferred?
An assessment of three domains is going to help the patient and physicians in this case: Patient related factors: A medical emergency that lasts three months implies a lot-- so what is the performance status of the patient now and what is the prognosis; because an ECOG 3-4+ patient with new onset mu...
Which patients, if any, do you offer transdermal estradiol as a method of ADT instead of LHRH agonists?
My default form of ADT remains a GnRH agonist or antagonist but estradiol transdermal patches are clearly effective and safe as an alternative option for men who either 1) have significant loss of bone density/osteoporosis, 2) have significant hot flashes with traditional ADT and wish to try an alte...
What is your approach to locally advanced pancreatic cancer that has not progressed after neoadjuvant chemotherapy +/- chemoradiation but remains unresectable?
NRG GI011 was recently activated across the NCTN and will test ablative radiotherapy in this setting. This is a pragmatic and potentially practice-changing trial. Consider activating it at your center. Here is a nice summary from the PI @Dr. First Lasthttps://www.youtube.com/watch?v=MNsS7pHqZIk.
Which GI cancer patients do you use oral contrast in staging CT scans?
We do not use oral contrast for most of our patients and only offer oral contrast CT scans for patients we are concerned about perforation.
Would you offer re-irradiation LDRT for someone with osteoarthritis or tendinitis if symptoms recur?
I have not personally offered a patient a third round of LDRT and do not know of any data that shows efficacy. However, I might offer a third round if a particular patient got adequate results with the first two and there was some separation in time (perhaps >1 year) since the last round.
Is there additional concern for late cardiac toxicity when using ultrahypofractionated breast radiation protocols, given that the BED to the heart is higher?
The BED to the heart isn't actually higher in this setting.Dr. @Dr. First Last explained this below, but I'll just explain it another way. Imagine that you place the block edge so that it is touching the heart (i.e., the heart is completely covered by the MLCs, and there is no margin between the MLC...
How do you interpret isolated PSMA-avid sites in a patient with prostate cancer with no pelvic or RP LN uptake?
The issue of false-positive PSMA scans is a vexed one, and we are still learning how to handle this optimally. My general approach is to think about the clinical context, level of risk, and whether an early diagnostic pick-up will actually make a clinical difference. For example, in a patient with ...
What is your approach to women with breast cancer who opts for a staged approach with up-front lumpectomy and SLN biopsy (pN-) when there are indications for adjuvant radiation therapy but she plans for a later mastectomy (=>6 months)?
That is not a common approach I have seen, and I would question the rationale of putting a patient through two surgeries when one can be done and forgo RT. If pN0, it would depend on what significant delay is, and I would extensively counsel the patient on recurrence risk should they end up forgoing...