Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
How would you manage a patient with a MALT lymphoma (H. Pylori negative) found incidentally in the surgical specimen at the time of sleeve gastrectomy?
MALT lymphoma tends to be a multifocal disease. Furthermore, imaging is often suboptimal in delineating the true extent of disease within many extranodal sites, including the stomach. For these reasons, the entire organ is typically treated during a course of radiation therapy. Historically, radical...
Would you offer radiation therapy for pleural- or peritoneal-based pseudomyxoma peritonei?
There are no published data that clearly support the use of radiation in this disease. In general, the best one could hope to achieve is to slow or arrest the mucin production from the cellular component of the disease. I have tried this with variable success using palliative doses.
How do you manage soft tissue necrosis in a patient who underwent TORS followed by RT?
Close observation Minimize trauma Don’t biopsy unless something very suspicious
What is your preferred workflow when treating AVMs with SRS?
There's more than one way to optimize workflow when treating AVMs with SRS and workflow may depend on the SRS modality. We have a Gamma Knife at our institution, a headframe placement is performed first followed by cerebral angiography, MR angiogram of the head and MRI Brain scan. All images are reg...
How do you approach positioning and irradiation of breast cancer in accessory breast tissue in the axilla? If the accessory breast tissue extends into the arm, how would you position/immobilize the arm?
Last patient I treated, I used a breast board with vacuum bag to immobilize arm for reproducibility as I had to treat the breast plus regional nodes.
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 dosimetric concerns do you have regarding PMRT in patients with magnetic valve tissue expanders?
This article gives some guidance for dosimetry and plan
What are the clear criteria for unresectability in locally advanced NSCLC patients, other than medical or anatomic?
Unfortunately there is not a clearly defined criteria to answer your question. As you stated much of the debate is centered around what is "resectable N2" disease. Since there is no clear definition of what surgically resectable N2 disease much of these treatment decisions are dependent on individua...
How do you identify immunotherapy-related pneumonitis vs. radiation pneumonitis in a patient status post chemoradiation receiving consolidation immunotherapy?
Unfortunately, it can be quite difficult to discern the two. Radiation pneumonitis is classically more focal within the treatment field, however, it is absolutely possible to get a more diffuse pneumonitis even with focal RT (albeit uncommon).https://www.ncbi.nlm.nih.gov/pubmed/15256622Immunotherapy...