Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you include the tract in your treatment field in a patient with squamous cell carcinoma of the anal canal presenting with an ano-cutaneous fistula?
I don't know that there is an evidence-informed answer, but I just had this in a patient recently. We had him get a diverting colostomy prior to starting CRT, then treated him with standard CRT with 5FU/MMC. I included the fistula tract in an intermediate dose, but with a margin on the boost to tumo...
Would you offer radiation for suspected retroperitoneal nodal metastases in a patient with metastatic colorectal cancer with a single liver metastasis who had an excellent response to neoadjuvant chemotherapy?
Yes, in the setting of all other disease likely controlled and response to systemic, the control of the RP nodes (gross and microscopic) should be considered definitive and curative. RP/PA nodes should be considered N2 rather than M1. As such, elective nodal RT should also be given with IMRT, not SB...
Do you routinely contour spinal nerves as avoidance structures for spine SBRT/SRS cases other than those for the brachial and lumbosacral plexuses?
In my practice, I do not typically contour spinal nerves as OARs other than those for brachial and lumbrosacral plexuses. Radiculopathy can occur but it is usually well tolerated and self-limiting. In my experience, the rate of persistent radiculopathy is very low.
How does surgical management of the ipsilateral cN0/pN0 neck with SLN vs standard neck dissection impact your adjuvant elective neck dose in oral cavity cancer?
Correct me if I am not interpreting the question correctly, but I infer that there is a primary indication for XRT, and the question relates to, since you need to treat the primary, what elective dose should the neck be prescribed, and how should it be determined to be N0 influence dose decisions? G...
How would you treat recurrent unresectable skin nodules on the chest wall after mastectomy and axillary lymph node dissection?
I would consider systemic treatment first based on phenotype to see if that could make it resectable.I would favor that, as surgery followed by RT would offer a better outcome.As for as RT field is concerned, I would treat chest wall and regional nodal region routinely for the recurrent disease in c...
How do you treat dermal metastases in the setting of prior breast irradiation?
There is no fixed approach. Based on effect and volume of prior RT, interval since last treatment, extent of dermal mets with or without surgical excision, and intent of care. One can do conventional fraction RT with or without hyperthermia, based on availability and gross or microscopic disease.
For patients undergoing breast conservation therapy, how do you ensure dose to the skin during treatment planning?
When possible, we use the lowest energy beam for our tangents (6 MV) to ensure dose to the skin. In larger patients or those with larger separations,we may add in higher energy beams which will reduce skin dose. In light of growing data on partial breast, I down worry about under dosing the skin. Th...
Would presence of DIEP flap reconstruction impact your decision to proceed with a BID approach to PMRT for inflammatory breast cancer?
The short answer is no. I would first carefully review the history that led to an IBC patient having immediate reconstruction since immediate reconstruction is not recommended and it warrants a careful review. Ideally, the patient would have upfront photos of skin involvement, bilateral nodal evalua...
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 dose regimen do you use when a women with inflammatory breast cancer is not responding to chemotherapy and needs radiation prior to surgery?
The data suggest pre op RT can convert some of these inoperable patients to surgery. I use comprehensive RT to preoperative dose of 50 Gy in 25 fractions in these patients