Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a periungual squamous cell carcinoma of the thumb?
Digit-sparing margin-negative excision if possible. If amputation is the only surgical option, then consider definitive RT, reserving surgery for salvage.
Would you offer adjuvant radiotherapy to a young patient with microinvasive lobular carcinoma (< 1 mm) in a background of LCIS?
I would favor RT as part of BCS but would also like to know the LCIS type (pleomorphic or not) to better quantify the risk of IBTR.
What dose constraint do you use for the spinal cord and/or cauda equina for a spinal meningioma?
Presumably WHO 1. 50.4/28 fractions. Good control. Low risk of injury.
How do you time PET/CT surveillance and COVID boosters?
I have not changed the timing of PET surveillance imaging around vaccinations but 1) is a frequent question from patients, and 2) I have seen a fair amount of false positive FDG avid axillary adenopathy post-vaccination. Think this tends to be too unpredictable in the duration of these imaging findi...
What approach do you take to determine dose constraints for SBRT reirradiation of the head and neck?
There is likely no "safe" dose when delivering full-dose SBRT overlapping tissue that previously received 40-70 Gy. The best you can do is make sure the patient understands the risks, that this strategy fits their goals of care, that you've considered all alternatives, and that you approach planning...
When starting HN radiation, which start day do you prefer to add most value to the treatment course?
Not sure there is really strong data on the preferred day to start. With a 35 conventional fraction HN plan, starting on a Monday ends on a Friday (assuming no holidays or missed treatments). With the same assumptions, starting on a Tuesday ends on a Monday, etc. So personally, haven't been dogmatic...
What is the role for molecular agents alone for medically inoperable NSCLC who is not a good candidate for chemoRT?
If medically inoperable and deemed not a chemo candidate, my preference would be definitive RT alone using a hypofractionated approach to account for the absence of radiosensitizing chemotherapy even for patients with targetable driver mutations. The best data we currently have would then say to con...
For patients with peritoneal carcinomatosis and minimal response to neoadjuvant chemotherapy, is there a benefit to palliative cytoreductive surgery followed by whole abdominal radiotherapy?
The prognosis for individuals with peritoneal carcinomatosis is generally bleak. Administering radiation therapy to manage gastric, colon, or appendiceal cancer is exceptionally challenging due to the imperative to safeguard the delicate large and small intestine. One potential exception arises when...
Would you order a DEXA scan for a cervical cancer patient with osteoporosis?
This is a great question and one that we should all be contemplating. I do order Dexa scans on all of my post-menopausal patients if they have not had a current baseline. Many of them have lifestyle issues that could also have decreased bone density such as low weight, tobacco and alcohol use, etc. ...
How do you approach SBRT and constraining healthy liver for a small liver?
Unfortunately, there is no simple answer to this question. Someone with 700 cc of liver could be doing quite well or on the verge of (or in) liver failure. If their liver function is poor and they only have 700 cc of liver, there is a better chance that you will hurt the person by treating them with...