Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you deliver post-operative axillary radiation for breast cancer patients who have contralateral axillary disease s/p ALND?
For recurrent disease involving contra lateral axilla, I have treated undissected axilla and supraclavicular region only (not contralateral breast or chest wall).
How can oncologists be more collaborative with palliative care physicians?
First and foremost, for oncologists to be collaborative with palliative care physicians, a trusting relationship is a must (good communication amongst teams is key to optimal patient care). This is akin to PCP-Oncologist (or even PCP-any other specialist relationship). Before advances in science and...
When would you offer radiation for poorly differentiated thyroid cancer?
PD thyroid cancers are rare, of follicular origin, often iodine unresponsive, and can be addressed with surgery and postop RT. More advanced disease presentation is a much larger issue and DM rates are as high as 60% with poor response to systemic therapy to date. Unlike anaplastic thyroid cancers t...
How does depth of invasion factor into your decision making when considering postoperative radiotherapy for vulvar cancer?
I would not offer adjuvant RT for depth of invasion as only risk factor.
How do you manage post radiation chronic vaginitis with bleeding?
Limit trauma to the area. No biopsies unless absolutely necessary. Can use vaginal packs on a short term basis (don't leave in too long). Transfusions if indicated. Can try a course of metronidazole, which can treat an anaerobic infection, but also is purported to have oxygen-mimetic properties. Thi...
How do you counsel patients who want breast augmentation following breast conserving surgery and whole breast radiation?
I usually start by trying to better understand why they want to do this. I try to reinforce that the majority of patients have good to excellent cosmetic results (by both the patient and provider assessments). I emphasize that there will be continued anatomic changes in the breast post-RT (likely fr...
Would you treat primary small cell cancer of the trachea with spread to paratracheal lymph node any differently than a limited stage SCLC?
I would treat this the same as limited stage SCLC. This is not particularly common, though, in these settings, I do work closely with our interventional pulmonary team to preserve the airways while starting treatment, and maybe a situation to consider inpatient treatment for close monitoring, depend...
Would you offer adjuvant radiation for a low-grade cutaneous leiomyosarcoma after R0 resection?
I would not. Cutaneous leiomyosarcomas are relatively favorable lesions with low propensity for recurrence as long as surgical margins are widely negative. The skin is easily surveilled and a local recurrence, in the unlikely event one occurred, would be easily salvageable. I would omit radiation an...
How do you counsel patients regarding timing of dentures after definitive/post-operative H&N radiation with pre-treament tooth extractions?
Wait for at least 3 months for acute healing and for the first post-tx scans to be NED. After that, there can still be subacute changes over the next 6-12 months (post extraction bone resorption, post radiation fibrosis, etc) that would lead a prematurely fabricated denture to lose appropriate fit. ...
Would you offer SBRT to an oligometastatic non-vertebral bony site that already has a pathologic fracture?
If it’s a rib or non-long bone lesion (as they won’t severely impair limb function), SBRT can still be a treatment option. If there is good tumor response, remineralization may occur. For long bones, open reduction + internal fixation have to occur first as in all likelihood, there’s limb deformity ...