Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you use bolus in patients s/p mastectomy and reconstruction if they had dermal involvement?
Pathological dermis involvement is a risk factor of LR and I would use bolus for this situation.
Is it appropriate to use bolus with hypofractionated PMRT?
Bolus is being used less and less. Most people would only use if T4 disease or if they had a positive margin or some other high-risk factor for skin/superficial recurrence. The indication for bolus would not change based on fractionation. If there was an indication to bolus with conventional, then y...
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.
Are there any special considerations for patients with Facioscapulohumeral Muscular Dystrophy (FSHD) requiring chemoradiation for HNC?
I am sorry but I have no experience with this disease and its implications for radiation therapy in head and neck cancer patients.
What changes do you make in the management of non-endemic nasopharynx cancer compared to endemic?
a) There are 3 varieties of NPC; EBER +ve, HPV +, and non-viral There is only decent data for Induction (IC) for EBER +ve for a small survival benefit with cis-gem, and the group's follow-up suggested that pre-treatment DNA titers only showed benefit for those with high titers. I am not a HN med onc...
Can the radiotherapy dose be reduced in patients with head and neck cancer who have a complete response to induction/neoadjuvant chemotherapy?
Agree with Dr. Kimple, and some more comments:While the prognosis of patients with HNC achieving CR after induction chemo is better than of those who do not achieve CR, there is no level III evidence that reducing RT intensity in those achieving CR is safe. Randomized studies of induction followed w...
How would you manage the primary site of a metastatic nasopharyngeal cancer showing cCR after systemic therapy?
Small phase III randomized trial of metastatic nasopharyngeal cancer patients with a CR/PR by imaging after 3 cycles of cisplatin/5FU showed that RT+chemo (primary/nodes + elective nodes) had an overall survival advantage compared with chemotherapy alone (You et al., PMID 32701129).
How do you delineate target volumes for patients who receive induction chemotherapy prior to definitive chemoradiation for locally advanced head and neck cancers?
We almost always evaluate our patients prior to start of induction chemotherapy (unless referred from outside) for a physical examination and ordering all diagnostic tests. The main principle to keep in mind is that all pre-chemotherapy extent of the disease should be included in the treatment volum...
Can the elective target volume in nasopharyngeal cancer, as specified in RTOG 0615, be reduced if OARs do not meet constraints?
Always protect the brainstem, spinal cord, and chiasm and by that, there will be some compromise of the target. One should not change the target.
Would you offer APBI in a patient with Paget's disease?
If breast MRI followed by central lumpectomy confirms DCIS with negative margins, then I would offer APBI with the same principle as used for DCIS.