Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat the chest wall alone in a patient that had a previous prophylactic mastectomy and later developed an early stage breast cancer pT1-2N0 after a "lumpectomy"?
If nodes are not assessed surgically this time, I would treat level 1 and 2 for sure with supraclv based on other risk factors.
Would you offer radiation to the contralateral breast if after neo-adjuvant chemo and prophylactic contralateral mastectomy yielded ITC only in a single lymph node and no breast primary?
Other factors would influence my decision. What was the burden of disease for starting NACT on ipsilateral side? Could this be spread from the contralateral breast to the lymph node? Was MRI imaging done prior to chemo? Did staging show any enlarged contralateral node? Pre-treatment work-up/findings...
Which chemotherapy regimen do you prefer for concurrent treatment with radiation therapy for anal squamous cell carcinoma?
When you have a highly successful treatment such as radiation with concurrent mitomycin and 5-FU in a rare disease such as epidermoid carcinoma of the anal canal, it is extremely difficult to improve outcomes by improving the chemotherapeutic/radiosensitizing effect. The recurrence rate is so low no...
What palliative radiation dose would you give to a patient with vulvar cancer who has an inguinal recurrence in a field previously irradiated with 45 Gy?
If only site of relapse, I would treat with definitive doses to the volume based on previous treatment and use conformal RT to avoid femoral head and neck region.
What combination of clinical and pathologic features would lead you to be comfortable recommending active surveillance in a Gleason 7 prostate cancer patient?
Active surveillance (AS) is an important option for prostate cancer patients, especially for low risk prostate cancer. For intermediate risk prostate cancer, the risk of AS increases somewhat but the benefits of AS remain. To keep the risk of AS acceptable, one should select intermediate risk patien...
Should chemoradiotherapy to primary and neck be offered to patients with Stage IVC nasopharyngeal carcinoma with limited osseous disease?
Yes. Please refer to the recent small phase III randomized trial: You et al., PMID 32701129. Anecdotally, I have treated an Asian patient with EBV-associated NPC who had a single sternal met at presentation with definitive chemoxrt (no induction) who is is ~7 years post treatment and is NED.
If small cell carcinoma was found in an axillary lymph node with an unknown primary, would you recommend axillary lymph node dissection prior to chemoradiation?
Just to be clear, is this a patient with lung cancer? I know this is posted in the thoracic section, and has been responded to by a thoracic specialist, but usually “small cell carcinoma” in axillary lymph nodes without disease (especially in the thorax) elsewhere is Merkel cell carcinoma (cutaneous...
Do you consider adding a brachytherapy boost to IMRT in patients with cT3b and/or cN1 prostate cancer?
For T3b disease we do consider a brachy boost. We look at MRI imaging and based on extent of involvement which usually is to proximal part, and if it appears we can implant that area to full dose, we consider a brachy boost.
How would you treat a pediatric embryonal rhabdomyosarcoma of the kidney with preoperative rupture s/p nephrectomy and getting VAC/VI chemotherapy?
This is an uncommon clinical presentation. If there was diffuse abdominal spill, then whole abdominal radiotherapy would be indicated. Though recent COG study guidelines specify 24 Gy whole abdomen radiotherapy dose, that may not be adequate for microscopic tumor. In other tumors (ie, diffuse small ...
Do you recommend elective lymph node irradiation for a basal cell carcinoma of the skin that is deeply invading muscle?
The decision to treat lymphatics would depend upon the level of differentiation of the basal cell carcinoma. It is not unusual for a large [4 cm] lesion to deeply invade and destroy surrounding normal tissue. This does not necessarily mean that it will have spread into the lymphatics. Over the past ...