Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you include interconnecting skin in the radiation volume for a patient with lateral forehead squamous cell carcinoma who will receive radiation to the surgical bed and preauricular lymph nodes?
Yes. It's the interconnecting in-transit lymphatics rather than the skin that is the actual target. Since these are very superficial, an electron field would do the job.
Would you consider palliative radiation for a bone metastasis while patient is on pembrolizumab and axinitib?
If the dose to the hollow organs (in this case, the esophagus) is low, it should be OK to give axitinib (with anti-angiogenetic property) concurrently with RT. If the amount of lung exposed to radiation is small, it should be safe to give pembro (risk of pneumonitis) together. The above comments are...
What is the role of MRI in target delineation of radiation therapy for non-NPC H&N cancers?
I don't think MRI is necessary for most OPCs. I do use MRI in some cases, such as 1) patients being considered for surgery first (to determine if endophytic tumor is better suited for RT), 2) whenever I have clinical concern for perineural spread, and 3) to further assess deep invasion or involvemen...
Is there an indication for bolus in whole breast RT for early-stage invasive ductal carcinoma with micropapillary features?
I have not and would not suggest changing RT management based on histology alone unless dermal lymphatics invasion was seen on pathology.
How would you approach adjuvant therapy for a patient with pT2N2 lung adenocarcinoma who underwent an R1 resection and is not amenable to further surgical intervention?
I don't know that I have a trial (much less a randomized one) to prove this, however in this situation, assuming the patient has adequate functional status and has recovered sufficiently from surgery, I would treat the surgery as an extended biopsy. I.e., I would probably (with my radiation colleagu...
Are there best practices or data regarding the use of open notes among oncology patients?
The 21st Century Cures Act regulation (effective April 2021) required that clinical notes such as consult and office notes be shared with patients, e.g. “open notes.” In general, surveys of patients with cancer and their clinicians suggest that open notes are viewed favorably (Salmi et al., PMID 330...
How would you treat prostate cancer that recurs after radical prostatectomy with invasion into bladder, rectum and musculature?
In a case with extensive disease like this, I would first restage ideally with a molecular study like PSMA to ensure no evidence of metastatic disease. In the absence of metastatic disease, I would recommend starting with ADT (+/- abiraterone or other novel anti-androgen) to downsize disease away fr...
For a patient with breast cancer s/p lumpectomy found to have a heterozygous RAD50 mutation, is adjuvant radiation appropriate therapy or would you recommend completion mastectomy?
Rad50 is part of the homologous recombination repair pathway. If cancer cells have homozygous loss of Rad50, they will be exquisitely sensitive to radiation therapy, which causes lethal DNA double-strand breaks via oxygen free radicals. Theoretically, adjuvant radiation is an excellent treatment bas...
Is there a role for radiation therapy for heterotopic ossification prophylaxis of the ankle?
Yes.
Do you offer adjuvant therapy for rectal intramucosal carcinoma within a large rectal adenoma?
Not if the margins are negative and it’s not into the muscularis.