Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you ever change your CNS radiation recommendations for patients with multiple sclerosis (MS)?
I will counsel patients with MS about potential increased radiation-induced toxicity for intracranial radiotherapy. As the publication states, the techniques used may not be comparable to modern techniques. I don't routinely defer radiotherapy simply because a patient has MS and would have a convers...
How would you manage locally advanced anal cancer patients with PET positive para-aortic lymph nodes?
I would recommend a curative attempt in such patients, based on the following 5 considerations:1. Para-aortic spread, although lumped together as stage IV in the AJCC 7th edition, is not the same as distant hematogenous spread. There is no magical line of demarcation at L4-L5 at which the lymph node...
How do you manage dysgeusia from head and neck radiation?
Though I don't know of any radiation or chemoradiation-specific data, there was a recent publication on taste disturbance in general (PMID29260510). Though rather unenthusiastic, this work affirms what has long been my practice, based on older works, namely to offer an empiric trial of modest dose z...
How would you manage an inguinal-only recurrence of a previously treated low lying rectal cancer?
Assuming that this is a patient who is received previous radiation to the anal canal but not the inguinal area, the management options include a radical inguinal dissection with or without radiation, definitive chemoradiation, and preoperative radiation by a more limited nodal dissection. We know fr...
What role, if any, should Ki-67 play in decision making about the role of adjuvant radiotherapy in patients who meet CALGB 9343 entry criteria?
CALGB /PRIME2 study didnt look at Ki67 but did notice grade 3 disease had higher risk of recurrenceThe Canadian study retrospectively did IHC using K167 14% as cut off for Luminal A vs. Luminal B classification and did notice that luminal B had higher IBTR than luminal A, although could not distingu...
What risk factors prompt you to treat an early-stage nasal squamous cell carcinoma of the skin with post-operative radiation to the primary and/or elective nodal radiation?
I would probably treat the site of the primary tumor if margins were positive and further surgery was not planned, tumor invaded to a depth of 6 mm or more, or there was perineural invasion of a nerve 0.1 mm or greater in diameter. I would probably not recommend elective nodal irradiation unless th...
What dose and fractionation scheme do you prefer for retreatment of meningiomas in close proximity to the optic structures?
This is a common problem. If the patient has never received prior radiation therapy and the meningioma is within a few millimeters of the optic chiasm, I discuss two options. The first option is to do standard radiation therapy, ie 5040 cGy in 180 cGy fractions, planned so that the maximum optic chi...
Do you routinely modify radiation treatment plans for patients with prostate cancer on chronic anticoagulation or with bleeding disorders?
I have not been modifying volume but do consider using space OAR as risk of rectal bleeding higher
Is surgery preferable over SBRT for peripheral NSCLC invading into ribs?
There is not much data about SBRT in tumor invading the rib. Technically, this is T3 disease. There are three uncertainties: 1. Chest wall toxicity. 2. Tumor contour and margin. 3. Optimal dose. Since surgical resection remains the standard care for operable disease, without further data, I would vo...
How do you decide on the sequence of systemic and local therapy for patients with oligometastatic NSCLC?
Since patients are already metastatic, systemic progression is the deadliest threat to these patients, so systemic therapy is most important. It will help select out patients with favorable biology that may benefit from aggressive local treatment. The trial that showed a PFS benefit sequenced system...