Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you consider adjuvant chemoradiation for resected pancreatic cancer with anterior surface “margin” positivity?
Whipple specimens are very difficult to process and evaluate. It requires collaboration between the surgeon and the pathologist to identify the relevant margins. I can't recall ever seeing this situation but it does not seem to me that the anterior peritoneal surface of the pancreas is a "true" marg...
In what circumstances would you recommend using DIBH in patients with breast cancer during an electron boost?
Sometimes use for breast boost for lower quadrant disease if exit beam is close to the heart to decrease heart dose.
What dose constraints for lung would you use in a patient with breast cancer requiring regional nodal irradiation who had significant pneumonitis during systemic therapy?
I would look into the absolute benefit of RNI in someone with significant pneumonitis as the downside may outweigh the benefit.
Would you irradiate elective lymph nodes for a T1 Merkel cell carcinoma of the head and neck with a negative sentinel lymph node?
In general, I would not irradiate due to the negative sentinel lymph node biopsy (SLNBx). Either one trusts the prognostication of a SNLBx and obtains one, or not. If one does not trust the process of SLNBx, then you should not obtain one and electively treat. I do not see the utility in obtaining a...
How do you manage severe fibrosis/contracture and breast/axilla pain in a patient with a history of breast radiation who cannot tolerate trental?
I have seen some patients with dramatic responses to pentoxifylline (Trental) and vitamin E, but the regimen needs to be continued for at least one year to prevent relapse (Delanian et al., PMID 12829674). However, this patient cannot tolerate Trental, so that is not feasible. Hyperbaric oxygen has ...
How would you treat a locally advanced breast cancer who had prior radiation to the contralateral breast over 10 years ago?
I would use partially wide tangent for breast and IM node with matching s/c and undissected axillary field. Dose 50 Gy in 25 fractions followed by boost to surgical bed and undissected IM node to another 10 Gy (have tailored dose to 55-65 Gy based on nodal size and response to chemo).Iyengar et al.,...
What is your experience and practice patterns when treating midline NUT carcinoma of the head and neck?
Of the neuroendocrine HN cancers, NUT cancers are very rare undifferentiated or poorly differentiated squamous cell carcinoma defined by rearrangement of the NUTM1 (aka NUT) gene. Due to the rarity of this disease, published reviews include mostly assortments of case reports with conflicting results...
How do you manage a symptomatic meningioma and associated vasogenic edema in a poor performance status patient?
Superficially, this resembles a straightforward question, but in reality, it is very nuanced, with numerous variables driving decision-making. My sequential "thought-experiment" in a situation like this would proceed as follows:1. Why does the patient have poor KPS? Are there underlying comorbiditie...
Would you offer adjuvant chemoRT to a patient who underwent neck dissection for a T0N1M0, p16+ head and neck squamous cell carcinoma?
Yes. At least the RT. Chemo would depend on the extent of neck disease. Multiple nodes and/or level 4, add chemo.
Would you consider salvage RT in a prostate cancer patient with controlled Crohns disease?
In my experience, I have now treated two patients with Crohn's with definitive (not adjuvant/salvage) EBRT. Both had quiescent disease for years, clinically and endoscopically/pathologically, and were not on any pharmacotherapy. Both tolerated treatment well with no acute/late toxicities. One was ve...