Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In which scenarios, would you consider a planned neck dissection following definitive radiation therapy?
Persistent induration despite a negative PET, particularly if HPV negative, or if unable to go to full dose.
What dose and fractionation regimen would you use for a patient with DCIS with multiple close margins unable to undergo re-excision, who has a history of photosensitivity (polymorphous light eruption)?
Generally, photosensitivity doesn't lead to higher photon reactions. That being said, I would get the pre-RT mammogram done to rule out residual calcification before RT and favor whole breast to 40 in 15 with higher 16 Gy equivalent boost dose.
What intracavitary brachytherapy dose (and fractionation) would you recommend for stage I vaginal cancer post-resection with positive (R1) margins?
Presuming nodes have been addressed or don’t need to be addressed. For brachy alone cases, I have done 6 Gy x 6 to GTV area with MRI planning with the first 4 or 5 fractions treating longer length especially if has VIN for microscopic dose and disease.
Would you offer radiation therapy for extramedullary testicular masses in the setting of multiple myeloma?
If a patient had a symptomatic plasmacytoma involving the testicle (which I don't think I have ever encountered), not responding to systemic therapy, palliative radiation therapy would be a reasonable modality. I would probably start with a very low dose and assess the response to therapy (2 Gy X 2)...
How do you approach the discussion with a patient who is seeking proton therapy for early stage breast cancer?
I would ask why they want protons. Assuming they give the expected answer, I would say something like this: “Thanks for asking about that. I certainly understand why you might feel as if protons would be better for you. I understand that receiving radiation can be scary, and indeed, radiation can be...
Per the latest ASCO and ESMO guidelines, which stage II NPC patients would you omit concurrent cisplatin?
ASCO recommendations for stage II NPC are: “For T2N0 (AJCC 8th) NPC patients, chemotherapy is not routinely recommended, but may be offered if there are adverse features, such as bulky tumor volumes or high EBV DNA copy number. For T1-2N1 NPC patients, concurrent chemotherapy may be offered, particu...
How would you approach a recurrent, cutaneous SCC of the face with high-risk features s/p resection?
Likely previously treated with 6 MeV. Reirradiate the primary site and track nerves to skull base. Electively treat the regional nodes.
In what situations, if any, would you recommend adjuvant concurrent chemoradiation rather than RT alone?
I think think this is head and neck cancer? Cannot tell based on the question. Positive margins from an oncologic surgery (i.e., simple tonsillectomy with positive margins does not buy you the juice). Any pathologic ECE in the lymph nodes. I don't differentiate between focal and diffuse. The origin...
Should patients with co-existing moderate-severe valvular disease (particularly AS and MS) and malignancy requiring radiation therapy undergo more frequent surveillance surface echocardiograms?
The answer is yes, for some patients with baseline moderate to severe valvular heart disease receiving radiation, with the heart in the radiation field (i.e. left breast, lung, esophageal cancers), they should have more frequent surveillance echocardiograms.The 2020 ACC/AHA valve guidelines recommen...
Should we repeat a dose-escalation trial for stage III NSCLC in the era of modern radiotherapy techniques and dose constraints?
Yes to a study with modern techniques. The outcome was so odd that high dose was killing patients at a higher rate than with standard dose, despite many phase II and retrospective studies showing good outcomes. The subset analyses showing that IMRT was associated with better outcomes as well as more...