Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When should vaccines be given if not received prior to the start of high dose radiation (40-50 Gy) to the spleen?
Mortality due to infections is increased in asplenic individuals as well as those receiving radiation therapy to the spleen. The risk is low but measurable. For example, in a large Childhood Cancer Survivor Study, the cumulative incidence (35 years) after splenectomy of late infection-related mortal...
What dose/fractionation would you choose for resected tail of pancreas adeno with positive margin, node negative?
62.5 Gy in 25 fx to the margin if R1. If R2, 75 Gy in 25 fx with motion management. Regional nodes get 45 Gy in 25 fx. Max point dose to the stomach and jejunum 60 Gy.
What dose fractionation would you utilize for a large solitary liver metastases about 7 cm, abutting colon?
Given that this is a solitary metastasis, I would favor surgery for this patient if adequate healthy liver volume can be spared and there are no other contraindications. This will offer the best outcome. If this patient is not resectable then the best regimen to treat this metastasis depends on how ...
Would you recommend radiation therapy for an adult patient with rhabdomyosarcoma (embryonal) of the upper extremity s/p amputation with multiple lymph node involvement and ENE on pathology?
Yes, I would treat the involved nodal region. This patient has what appears to be stage III, group 2c intermediate-risk disease. If treating per ARST0531 dose to involved nodal region would be 41.4 Gy in 1.8 Gy per fraction, though with ENE, I would consider escalating that specific area to 50.4 Gy ...
How would you treat an immunosuppressed patient with high risk cutaneous SCC of the axilla with node positivity on axillary node dissection?
I would probably recommend adjuvant radiotherapy to a dose of 56.1-60 Gy in 30 fractions, using integrated boost to regions where the gross nodal disease was prior to surgery. Scar should receive 60 Gy if there was extranodal extension. Elective nodal irradiation of the supraclavicular and internal ...
What early stage breast cancer patients would you give IOeRT?
I think given data from ELIOT update (11% LR with electron IORT vs. 2% WBI) and the TARGIT-A update, there is a limited role for IORT as monotherapy at this time, particularly when options like 5 fx PBI and 5 fx WBI are now possible. The ABS guidelines do not recommend either IORT technique which is...
Under what circumstances would you consider reirradiation for a patient with recurrent previously irradiated early stage laryngeal cancer now s/p salvage laryngectomy?
This type of patient would have been allowable on the GETUG trial which randomized patients after surgical salvage to no further treatment or re-irradiation with chemotherapy. The study showed a DFS advantage, but no OS advantage. There were more deaths due to treatment in the treatment arm (5 vs 0)...
Does the extent of ENE affect your recommendation for concurrent chemotherapy in HPV+ OPSCC patients planned for adjuvant RT?
I'm wary of de-escalating treatment without phase 3 data supporting that decision. So any ECE, I treat with 66 Gy and concurrent chemo.
What is your treatment approach for p16+ oropharyngeal carcinoma with one positive node on neck dissection?
The question is quite broad and covers varying scenarios. My sense though is the question is asking about if/when would I recommend adjuvant radiation if an unirradiated patient has a neck dissection and 1 node is found. I will address the scenarios where the primary is either absent (ie unknown or ...
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