Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage soft tissue necrosis in a patient who underwent TORS followed by RT?
Close observation Minimize trauma Don’t biopsy unless something very suspicious
What is your preferred workflow when treating AVMs with SRS?
There's more than one way to optimize workflow when treating AVMs with SRS and workflow may depend on the SRS modality. We have a Gamma Knife at our institution, a headframe placement is performed first followed by cerebral angiography, MR angiogram of the head and MRI Brain scan. All images are reg...
How do you approach positioning and irradiation of breast cancer in accessory breast tissue in the axilla? If the accessory breast tissue extends into the arm, how would you position/immobilize the arm?
Last patient I treated, I used a breast board with vacuum bag to immobilize arm for reproducibility as I had to treat the breast plus regional nodes.
What is your preferred approach to PMRT with inflammatory breast cancer with adverse risk features?
Our approach is same of 50 Gy in 25 fractions to CW and Regional node with higher boost dose of 10-16 Gy
What dosimetric concerns do you have regarding PMRT in patients with magnetic valve tissue expanders?
This article gives some guidance for dosimetry and plan
What are the clear criteria for unresectability in locally advanced NSCLC patients, other than medical or anatomic?
Unfortunately there is not a clearly defined criteria to answer your question. As you stated much of the debate is centered around what is "resectable N2" disease. Since there is no clear definition of what surgically resectable N2 disease much of these treatment decisions are dependent on individua...
How do you identify immunotherapy-related pneumonitis vs. radiation pneumonitis in a patient status post chemoradiation receiving consolidation immunotherapy?
Unfortunately, it can be quite difficult to discern the two. Radiation pneumonitis is classically more focal within the treatment field, however, it is absolutely possible to get a more diffuse pneumonitis even with focal RT (albeit uncommon).https://www.ncbi.nlm.nih.gov/pubmed/15256622Immunotherapy...
How would you manage an elderly patient with GE junction adenocarcinoma who is not interested in surgery and who has ulcerative colitis (not currently on medication or symptomatic)?
Ulcerative colitis is generally a disease limited to the colon, and is an important distinction from Crohn's disease, which is truly anywhere from mouth to anus in the GI tract. These two diseases are on a spectrum of inflammatory bowel disease and there can be some overlap, but in general I would p...
In patients witih locally advanced pancreatic cancer, how long would you wait after 1st line induction chemotherapy with FOLFIRINOX before you image for assessment of response and deciding about 2nd-line therapy?
We image with Ca-19-9 every 3 months and consolidate with ablative chemoradiation after a minimum of 4 months of FOLFIRINOX. We do not give second line chemotherapy for locally advanced pancreatic cancer unless patients do not tolerate FOLFIRINOX in spite of dose reductions, or experience progressio...
What is your approach to mediastinal-only failure outside of the previous chemo/radiation field for SCLC?
I would treat involved nodal stations with concurrent chemo and radiotherapy. I don't feel it is necessary to cover the whole untreated mediastinum. In terms of margin, I would review the detail CT and PET/CT images and balance the chance of lymph node microscopic disease and toxicities of radiother...