Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach a non-healing wound following lumpectomy for recurrent disease in a patient who underwent breast conservation therapy with radiation 10 years prior?
Can try HBO and plastic surgery closure at some point.
What dose volume constraints do you use for APBI using the Livi regimen for rib, contralateral breast and lung?
Marrazzo et al., PMID 35659597 This is our revised guidelines with nothing specific for ribs but with conformity and hot spot restriction, it is driven by part of the rib in PTV and dose criteria for PTV.
How well does left chest wall electron chest wall RT compare with IMRT with with respect to heart and lung radiation doses?
The acute skin toxicity is high, as well as the late telangiectasias. There can also be substantial variation in the skin surface contour of the patient, so really only patients without reconstruction and relatively ‘flat’ profile are suitable. Some have mitigated that by building custom boluses tha...
Is close observation a reasonable option for elderly patients with a small basal cell carcinoma of the face?
Yes, depending on life expectancy, logistics, and morbidity of treatment which would be minimal with RT.
How are you managing patients with H&N cancers meriting definitive concurrent chemoRT during cisplatin shortages?
If cisplatin cannot be used, other systemic therapies should be considered. The NCCN guidelines list various regimens, as noted below. Given the improvements in the delivery and quality of radiation therapy, I am a believer that single agent carboplatin (AUC 6 Q 3 weeks or AUC 2 Q weekly) can be sub...
Do you offer adjuvant osimertinib to EGFR exon 19 deleted patients with T2N0 NSCLC treated with definitive SBRT?
Given the fairly striking benefit of ADAURA in resected patients, there likely would be a locoregional and distant control and likely survival benefit to this approach but we don't have data to support this. PACIFIC-4 is currently enrolling. Study of durvalumab vs placebo in patients with early stag...
What systemic therapy do you recommend for prostate cancer pelvic nodal recurrence on PSMA PET-CT after prostatectomy and salvage radiation?
If the LNs are not measurable on conventional imaging and can be covered in the radiation fields, then for now I treat as high risk salvage setting. Usually suggest 2 years ADT and radiation. If the LNs cannot be covered in the radiation fields, or are measurable, then would also escalate AR-targete...
What is your local control approach to localized relapse of Ewing sarcoma in a site that was previously unresectable and received definitive radiation?
It depends obviously on some other factors including disease-free interval, the site itself, the dose of radiation received, symptoms, etc... Generally, a combined modality approach is attempted. Second-line chemotherapy with either high-dose ifosfamide, irinotecan/temozolomide, or topotecan/cycloph...
How would you approach a vulvar SCC with extension to the anal sphincter and inguinal nodes, 10 years after definitive chemoRT+brachy for a cervical cancer?
I have treated few in this situation. Limited to treating vulva, anal canal with the inguinal region with boost to GTV to 66 Gy EQ2 dose with concurrent cisplatinum, avoided any prophylactic nodal region including mesorectum or pelvic nodal region.
How do you decide whether to offer partial breast radiation to T2 tumors that are 2-3cm in size?
If otherwise technically suitable with favorable phenotype then do offer APBI.