Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the best approach to treat a triple-negative inflammatory breast cancer with pCR following preoperative chemotherapy and a prior history of ipsilateral breast irradiation?
Given inflammatory breast cancer recurrence, even with history of previous breast RT, I would offer reirradiation. Given DCIS, nodal irradiation would not have been used and the breast would be removed at mastectomy leaving chest wall. I would give dose of 50 Gy to CW and nodes, and I would use some...
What risk/pathologic factors merit PMRT for a patient with recurrent breast cancer and a prior history of ipsilateral breast irradiation?
My threshold for reradiation PMRT is higher. Would do for upfront 4 or more positive node or persistence of nodal disease after chemotherapy. If there is complete response to chemotherapy, then would avoid PMRT unless inflammatory breast cancer.
Have you utilized silicone-based film-forming dressings to prevent, minimize, or treat radiation dermatitis?
As the question author stated, Chan et al., PMID 31445838 from Queensland conducted an industry-funded single-blind randomized trial of StrataXRT (silicone-based barrier vs. Sorbolene) (glycerin-based emollient - standard arm) in 197 patients getting 50 Gy or more to the head and neck. They found a ...
When would you consider hyperbaric oxygen for skull base necrosis or temporal lobe necrosis following CNS/HN RT?
I agree with Dr. @Dr. First Last and would like to add a few details. If the patient is asymptomatic, there is a chance of regression of the necrotic lesion, and no therapy is indicated. In symptomatic patients, the first treatment line is steroids, and surgery if the lesion is resectable. The quest...
Do you recommend a specific XRT fractionation for young men with prostate cancer?
I don't think I would use a different curative dose or fields, but I would use protons. Greater longevity, like 40+ years, increases the risk of 2nd malignancy. The integral dose with protons is about two-thirds less than with Xrays, and the secondary malignancy rate reflects that. The risk is only ...
What is the appropriate management of breast cancer patients with axillary nodal involvement based on imaging (MRI or ultrasound) but negative axillary nodal involvement based on physical exam?
If concerning based on imaging, I would review with breast radiology expert to see if biopsy is possible, it's quite uncommon not to be biopsy. Also, regardless of the treatment approach (neoadjuvant chemo vs. upfront surgery), having a clip in the suspicious node is helpful to ensure it is removed ...
How would you manage an in-field small volume recurrence of early-stage favorable Hodgkin Lymphoma treated previously with 2 cycles of ABVD and 20Gy?
An established and extremely successful treatment paradigm for early-stage favorable HL is 2 cycles of ABVD followed by 20 Gy of RT. Assuming the patient is PET negative after chemotherapy, 5-year PFS is expected to be ~93-94% based on HD16. Most recurrences after combined modality therapy (CMT) in ...
In a patient who had a prior CABG with internal mammary grafting who now requires comprehensive RNI, what landmarks would you use to contour the IMN volume?
I am not sure I would treat IMN prophylactically in a patient with IM vessel graft for CABG.
Would you consider PMRT in a patient < 40 y.o with a with an ER/PR(+) Her 2(-) pT1, cN0 breast cancer patient, LVSI positive, who did not have sentinel lymph node biopsy?
She would need axillary nodal assessment with ALND or sampling based on pathology and would favor that for PMRT.
What dose and fractionation would you give for gastric cancer patient with solitary FDG-avid metastasis to gluteal muscle?
I believe you will get a variety of answers here, many of which will likely be biased based on the responder's training period and whether or not they subscribe to the evolving paradigm of the oligometastatic state. While gastric cancer is not heavily represented in the oligometastatic literature, i...