Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When treating a patient definitively for high risk prostate cancer, how would you interpret the interval development of sclerotic bone lesions that appeared during neoadjuvant ADT?
It most likely reflects treated metastatic disease but can be very difficult to prove, as bx yield is low since it has been treated. Would not change management and complete planned treatment. Stampede also showed benefit of local RT for limited bone mets
Would you recommend EBRT/brachythrapy for any patients with stage III- IV uterine ca in light of GOG-258 data?
GOG-258 will certainly change management approach. The recurrence pattern between the two arms (higher distant mets in chemo RT arm and higher locoregional recurrence in chemo alone arm) suggests that sequencing of treatment may also matter. Our current approach is to have chemotherapy first and con...
Would you offer adjuvant radiation therapy for high grade T1 nasal vestibule squamous cell carcinoma with negative margin (5mm) but positive focal perineural invasion?
Yes to the primary site and neck. I likely would have recommended RT rather than surgery at the outset
How long after biopsy is it safe to place rectal spacer when treating a patient definitively for prostate cancer?
Depends on the method of biopsy. Transperineal, think it would be safe to do this immediately. Transrectal biopsy I would be more concerned about infection and would wait 3 days.
Would you recommend nodal irradiation in a patient with breast cancer with a single positive sentinel node and a low Oncotype who does not receive chemotherapy?
Without knowing all the details, this sounds like a patient that may have been eligible for Z11 (early stage patients treated with BCS and SLN bx who were found to have 1-2 positive SLN then randomized to ALND vs no further surgery with all patients receiving at least tangents to breast). There was ...
How do you approach rectal cancer with a solitary bone metastasis that is biopsy proven?
This is a much less common scenario than oligometastatic disease to the liver or lung, but as control rates for bone metastases treated with SBRT are showing promise, the approach may be similar to that taken for patients with more common sites of oligometastatic rectal cancer. We would typically st...
How, if at all, do you use biozorb to help guide your external beam partial breast irradiation volumes?
I currently do not use Biozorb when I deliver EBRT APBI. I have had good success with 5 and 15 fraction PBI regimens using the seroma and clips. Also, the studies that evaluated EBRT APBI did not use the device. There are situations where it can be helpful for example with an UOQ tumor and a single ...
At what point would you no longer offer adjuvant radiation for adenoid cystic ca of the head and neck?
While the traditional start within 6 weeks is embedded in our postoperative management algorithms, and seems very intuitive, even this has little evidence to support it; though for SCC there is some literature to support the overall "package". Additionally, this is used to argue for the best outcome...
Would you consider adjuvant radiation for R1 resection for thymoma with solitary pleural deposit along diaphragm?
In my experience, anytime the pleural space is violated nothing good comes from it because if you "treat" one spot, others will pop-up which will ultimately result in the demise of the patient(s). There is a 1997 paper for carcinomas involving the p-space which indicated that these patients do much ...
Is it appropriate to treat unresectable secretory insulinoma of tail of the pancreas with radiation therapy?
Absolutely, it is the preferred treatment. Well differentiated functional NETs of the pancreas have been considered a resistant histology. However, the available data are based on palliative doses (BED<50Gy). It is an open question, but very likely that ablative doses (BED>100Gy) can overcome this r...