Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer consolidation RT to a young woman with bulky mediastinal DLBCL who achieved early and persistent CR to RCHOP on PET?
Dr. @Dr. First Last has modestly omitted one salient trial in his answer, namely the Duke trial which he led evaluating low dose consolidation RT (20 Gy) following CR to induction chemotherapy, i.e. PET negative response (Kelsey et al., PMID 30858144). To recapitulate briefly, 62 patients with stage...
Are there circumstances where you would use hemibody irradiation?
I have used hemibody radiation with some regularity for widely metastatic disease, particularly for relatively radiosensitive solid tumors such as breast and prostate, and have found it particularly helpful for multiple myeloma where it can and often does work wonders for pain relief. In addition to...
How would you manage mild SUV uptake at a 3 month PET/CT scan post chemoRT scan for a SCC of the cervix?
Typically at our institution, we would decide the next steps based on her exam findings. If there is concern for residual disease, we would either biopsy or see the patient back in a short period of time for a repeat exam. If there is nothing convincing to biopsy, we would likely repeat the PET/CT i...
Is post-operative radiation therapy indicated for a sigmoid colon cancer above the peritoneal reflection status post resection with operative/pathology findings of positive lymph nodes below the peritoneal reflection?
Yes.
How would you approach a patient with progressive muscular dystrophy affecting the pharyngeal muscles who needs treatment for a p16 positive base of tongue cancer with bilateral neck disease?
Deescalate.
How would you treat low grade primary breast Leiomyosarcoma following lumpectomy?
Limited data. I would favor a wider margin as the current margin is less than 1 mm and favor re-excision. After surgery, I have used the principle of organ/limb preservation prospective studies on soft tissue sarcoma and offered/considered adjuvant radiation.
Would you offer adjuvant capecitabine in a patient with nasopharyngeal carcinoma who has had cisplatin - gemcitabine induction followed by chemoradiotherapy with cisplatin?
There are now two randomized, published studies in patients with locally advanced nasopharyngeal cancer whereby capecitabine is administered in the adjuvant setting [1], [2]. Both studies demonstrate adjuvant capecitabine improves failure free survival or local control of disease. The combination of...
How do you decide whether to recommend surgical stabilization prior to RT for a femoral neck metastasis?
MIRELS score.
At what heart dose would you prospectively refer a patient to cardiology due to anticipated long term risks?
If a patient had prior BCT and now inflammatory, I would refer given the most likely plan for additional chemotherapy and RT. In general, I refer for cardiac oncology based on a combination of cardiac risk factors (HTN, DM, HLP), family cardiac history, anthracycline receipt, and cardiac dose (ex. I...
What elective areas are you comfortable omitting in the N0 neck for NPC?
Based on the data from China, I would consider omitting levels IV and VB for the N0 Neck.