Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you include the mesorectum for definitive cervical cancer patients getting concurrent chemoradiation followed by brachy?
I would also include it if there is direction invasion into the mesorectum or EMVI.
For patients starting Pluvicto, do you have patients stop their ARPI?
While the VISION trial allowed for concomitant use, it was only about half (53%) in the Lu-177-PSMA arm, and 2/3 (68%) of those on the standard of care arm - Garje et al., PMID 36693228. And the PSMAfore trial did not, as noted above by @Dr. First LastThe bigger question is, will you continue the AR...
Would you treat patient with early stage unfavorable classic Hodgkin lymphoma with 6 cycles instead of 4 cycles of Nivo-AVD to avoid mediastinal radiation in young female?
I would tailor the number of cycles to the clearance of PET positivity. If one is considering stopping at 4 cycles, I would do a PET scan after 2 cycles and only stop at 4 if it was negative. If it is positive after 2 cycles, I would repeat the PET scan after 4 cycles. If it is still positive, an al...
Would you use CT planning to treat a large keloid of the scalp post operatively?
We use a CT sim for almost all keloids, especially those where complex planning may be needed.Depending on the size and shape, you can even consider more complex treatment approaches, as noted in this case report: Ilori et al., PMID 35755175.
What dose-fractionation would you recommend for a small basal cell carcinoma of the nasal ala in a patient with poor performance status or transportation difficulties?
I would suggest several caveats to the above answers. Electron distributions are unpredictable, particularly on curved surfaces and in small fields. The larger margins required would likely be problematic on a nasal ala, and orthovoltage or HDR brachy would be preferred for fields 3 cm or less to av...
What adverse features would prompt you to give post-TORS radiation therapy to completely resected early stage (T0-2) p16+ tonsillar cancer?
I would base my recommendation on the standard and conventional indications for PORT, which in this case of an early-stage primary tumor with negative margins, would comprise the presence of PNI, LVI, close (<3-5 mm) margins, single node >3 cm, or multiple positive nodes. I assume there is no extrac...
Considering the surgical margins used in TORS, is it necessary to cover the entire tongue base with an elective dose in IMRT of cT1-3 HPV+ squamous cell carcinoma grossly involving one side of the base of tongue?
Frankly, I see no point in doing TORS if a patient is likely to require postop RT unless you believe that you can safely treat neck only (which includes unavoidably part of the ipsilateral oropharynx to irradiate the RP nodes). And I do not (but have been wrong before). Particularly HPV positive non...
What radiation doses and subsequent treatment monitoring would you recommend for multiple myeloma patients with multifocal bony lesions who decline chemotherapy?
Systemic therapy is the cornerstone of treatment for multiple myeloma, and the vast majority of patients initiate an appropriate regimen upon diagnosis. Occasionally, patients will have very limited disease and will be referred to Radiation Oncology for consideration of local therapy to delay the ne...
When you treat postop head and neck cancer, do you typically add a CTV margin to the delineated postoperative bed, or just treat postop bed plus PTV margin?
We don't ever have a CTV margin. It is postop bed which accounts for all pre-surgery GTV and all postoperative changes on imaging, also review the op note and path. We then add a 3-5mm margin to account for set-up.
How do you determine the timeline for healing after craniotomy prior to starting chemotherapy and radiation?
I typically wait at least 10-14 days post-op, always after neurosurgery has re-evaluated the craniotomy site for appropriate healing and has already removed staples or sutures.