Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you alter your treatment algorithm for uterus mesonephric-like adenocarcinoma?
Would strongly recommend VCB regardless of other pathological factors for a mesonephric or mesonephric-like adenocarcinoma. We generally treat these similarly to type II (serous/clear cell/carcinosarcoma) endometrial cancers and recommend chemotherapy as well, especially if myoinvasive. No prospecti...
What radiation would you offer for isolated nodal recurrence in a patient who received APBI for breast cancer about 2 years ago after ALND?
If imaging is negative for IBTR, I would favor regional nodal RT only after dissection.
How do you handle the obturator prosthesis during radiation delivery for SCC of hard palate?
Leave it in if it’s not problematic.
How would you manage a Grade II IDH mutant astrocytoma with otherwise low risk features, but gemistocytic histology?
Not sure there is a right answer for this one - in general, for an IDH mutant grade 2 astrocytoma with low risk features, I would consider observation. If all else is low risk with the exception of gemistocytic histology, I may still consider observation and counsel the patient about an increased ri...
How would you approach a stage III NSCLC that is a biopsy-proven new primary located in the same field as a prior stage III NSCLC previously treated with chemoRT?
First, I'd need to know the interval since the previous course of radiation. If it was recent, this may simply be the growth of a resistant subclone. Next Gen sequence comparison can be helpful here. If the interval was >3 y, it may well be a new cancer. I would give the patient the benefit of the d...
How does residual DCIS after neoadjuvant chemotherapy impact prognosis if there is a CR of the invasive disease?
The majority of studies suggest residual DCIS has the same outcome as pCR with no invasive disease and thus is still treated as pCR in practice.
Would you consider pelvic radiation in a patient with prostate cancer and myelofibrosis with mild cytopenias?
I would avoid prophylactic RT in this scenario as the absolute benefit has to be weighed against the worsening of cytopenia.
How would you approach management of a patient who is status post resection of a WHO grade 1 planum sphenoidale meningioma which was adherent to the optic nerve?
As suggested by the mere fact of its posting, this is a complex question. If this were a gross total resection (GTR), I would tend toward observation and would follow the patient carefully with imaging and clinical evaluations at 6-month intervals for at least 3 years, then annually. GTR for a planu...
For an atypical meningioma WHO grade 2 s/p GTR, do molecular findings that suggest an integrated diagnosis of a grade 3 tumor change adjuvant radiation treatment recommendations?
There is no definitive clarity on this question, as the data simply do not exist. Therefore, decision-making has to be individualized. For residual disease, the GTV would be easy to estimate, but it might be prudent to utilize the pre-op scans in these patients to understand the pre-op GTV, which co...
What rates of breast (not arm) lymphedema would you quote to patients post-lumpectomy and adjuvant radiation?
The UK trials report on breast edema and provide helpful numbers for counseling patients. For instance, in the UK IMPORT HIGH trial (hot off the press!), rates of breast edema in the sequential boost arm (40 Gy + 16 Gy boost) were 90% none, 7% mild, 2% moderate and <1% marked. In the lower SIB arm (...