Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In the case of a high upper outer quadrant early stage breast cancer without adverse histological factors, would you omit boosting the breast lumpectomy cavity if the treatment area would involve a significant portion of axilla due to risk of lymphedema?
There is a great thread on when to boost from TheMedNet- so that's a good place to start - to figure out if they need a boost or not. It shouldn't be just histologic factors - age is also important. To paraphrase, what they said - if you'd consider skipping RT altogether, then those patients don't n...
In contemplating neoadjuvant RT, how would you manage a large, non-RT-induced angiosarcoma of the right breast in a young female?
I would have her get a mastectomy first. 1. You want your surgeons in their comfort zones. Preop treatment of any sort is a discussion to have with her surgeon in advance of doing anything. Breast surgeons who see 99.9% adenocarcinoma are used to preop chemo but not usually preop radiation. 2. Radi...
What adjuvant therapy do you give after surgery to patients with gastric CA who undergo 3 cycles of FLOT with no tumor effect on pathology and maintain good PS?
I know I'm not a medical oncologist in a question (and disease site) geared towards med-oncs, but I would caution against such definitive statements about RT (agree with @Dr. First Last on ECF) when subset analyses of the CRITICS trial evaluating the role of TRG (along with other factors, such as no...
Would you offer chestwall RT after capsultectomy+explant for an implant-related ALCL?
Breast implant-associated ALCL is a provisional entity in the most recent WHO classification system with a relatively low incidence. In contrast to most other lymphomas, surgery plays an integral role in the management of this disease. Most patients present with a spontaneous fluid collection around...
How do you deliver whole breast radiation to a woman with pectus excavatum?
Agree that these can be challenging cases. The technique used depends on the severity of the pectus deformity, need to treat regional nodes (particularly IMNs), and need to treat the whole breast.@Dr. First Last's advice is sound regarding multiple different plans may be needed and then the optimal ...
Would you recommend Radium-223 for extensive bone disease in a prostate cancer patient with adenopathy >3cm?
I think that there are several nuances to this question. One, Xofigo is a calcium mimetic which has shown both overall survival advantage as well as improvement in symptomatic skeletal events for men who progressed on docetaxel or refused chemotherapy in the ALSYMPCA trial. Patients experienced less...
How would you manage lung adenocarcinoma in a patient with an index lesion requiring treatment, who has additional slowly evolving GGOs/subsolid nodules?
In our institution, when dealing with the patient who has multiple GGOs, treatment is usually initiated when serial CT imaging shows growth AND development of solid features in a given lesion. We attempt to biopsy if not medically contraindicated and do formal staging including PET and EBUS staging,...
Would you consider cystectomy in a patient who acheived radiologic and cystoscopic CR from chemo-radiation for oligometastatic urothelial carcinoma originating in the bladder if remains disease free > 6 months?
For this patient, I would currently recommend 4-6 cycles of cisplatin based chemotherapy followed by avelumab switch maintenance therapy. I would strongly consider radiation or chemoradiation after the combination chemo directed at the bladder and lymph node, followed soon after by avelumab. I think...
If you saw a medically inoperable patient for chemoRT for muscle-invasive bladder cancer who had a congenital recto-urethral fistula, would you deliberately exclude the prostate/prostatic urethra from the target volume?
First, I would want to know about this fistula and why it couldn't be addressed when the patient was a child (what other medical factors might be involved?). Also, the exact location of the fistula would help inform a response to this question. Finally, the nature and location of the bladder tumor i...
Do you consider SABR for oligometastatic disease in patients with TP53 germline mutation?
The question at its core is asking would you give RT to a patient with a genetic condition making them more susceptible to RT-induced secondary cancers. This case discussed TP53 mutation associated with Li-Fraumeni syndrome.However, the case is a patient with oligometastatic disease. This is challen...