Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is a close (<1mm) posterior margin an indication for lumpectomy cavity boost in a patient with early stage breast cancer when dissection was carried down to the pectoral fascia?
In the setting of invasive breast cancer, a meta-analysis and guidelines have determined a negative margin is no tumor on ink. So as long as margin is > 0, I would not consider a close margin (often considered for 0-2 mm) to be a sole reason to boost. In the setting of pure DCIS, current guidelines ...
How does the presence of ascites affect your treatment planning for SBRT for HCC?
This is not an unusual situation in clinical practice, as it is common for HCC patients to have both benign and malignant liver disease. It is important to weigh the risks of aggressive SBRT in the setting of malignant ascites. In my practice, I find it is rarely the appropriate option. However, if ...
Would you treat the contralateral neck in post-op parotid salivary gland malignancy with multiple positive nodes ipsilaterally?
Not unless there are suspicious contralateral nodes. Parotid drainage is ipsilateral and it makes no clinical sense to me to treat CL neck electively.Of note, the paper cited is on submandibular gland cancers, not parotid. With SMG, there is a chance of CL mets if the initial presentation has very a...
Should radiation oncologists advocate for changes in the USPSTF guideline that recommends lung cancer screening for patients as long as they can undergo curative lung surgery, but currently omits the concept of curative radiation therapy?
The 2021 update to the USPSTF Lung Cancer Screening Guideline specifically states that "Screening should be discontinued once a person...develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery". I agree with this sentence, excep...
How would you approach definitive RT for mid-esophageal cancer in a patient who declines or cannot get chemotherapy?
RT alone. 70/35. I know, stop at 50. Pall RT.
In what clinical circumstances would you consider re-irradiation for skin cancer?
I consider reirradiation for skin cancer when I know why radiotherapy did not work the first time it was applied. This is usually a total dose, targeting or dosimetry issue (i.e., total dose was too low, target was too small, dose was not delivered to target correctly). Treatment approach depends on...
Can CM577 regimen of adjuvant nivolumab s/p neoadjuvant chemoRT with residual disease following surgery be extrapolated to patients with R1 resection unable to undergo re-resection?
This is an excellent question and, of course, one for which there are no data. So, unburdened by data, I'm free to offer my personal opinion. I think all of us would value other comments and responses to this question as well.I think that this question also applies to those patients who achieve a cl...
How young is too young to treat a child's keloid with radiation?
I think this is a helpful question and I think the following questions appropriately highlight the considerations. We do not routinely see or manage these at our center, so I welcome comments from the invited respondents.This is a controversial area and I think there are certainly exceptions which s...
When do you offer adjuvant radiation therapy for high grade non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) in a skeletally mature teenager or young adult?
ARST0332 tested whether a risk stratification system based on clinical prognostic factors would separate young patients with non-rhabdo STS into different prognostic subgroups and whether each factor used for allocation would be a strong predictor of outcome. A combination of factors was used to ass...
Would you offer radiation to an elderly patient with cT2N1 triple negative breast cancer, whose lumpectomy and ALND showed a complete response to neoadjuvant chemotherapy?
Yes, would offer. This question is to be answered on NSABP B51, in regards to how to manage the axilla in patients who have a complete response in the nodes. All patients with intact breast receive at least breast RT. The primary endpoint is if breast/chest management with or without RNI will reduce...