Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your approach to postoperative radiation therapy in a patient with INTERMEDIATE grade early stage (I/II) mucoepidermoid carcinoma of the parotid and no other risk features?
Treat like a low grade. There are clear data on this point. Negative margins, follow even if close.
What consolidative radiation volumes and dose would you use for plasmablastic lymphoma of the L maxilla s/p incisional biopsy and 6 cycles of EPOCH-R?
Plasmablastic lymphomas are particularly aggressive NHLs with features of both plasma cell neoplasms (e.g., CD138 positive) and B-cell lymphomas, but they are usually CD20 negative. They frequently arise in the oral cavity. Underlying immunodeficiency such as HIV infection is common. There is arguab...
Would you treat regional lymph nodes in an elderly patient with a triple negative pT2 IDC of the UOQ of the left breast s/p lumpectomy with N0 sentinel node biopsy, but was clinically node negative?
What was the reason SLNB was omitted? While pathological nodal assessment is sometimes omitted, that most commonly applies to patients who are older (age >70) with small (T1) tumors that are ER positive, paralleling the inclusion criteria of CALGB 9343 in which 2/3 of patients did not have pathologi...
What radiation approach do you prefer when using total neoadjuvant therapy for rectal cancer with extensive anal sphincter or pelvic floor involvement?
Yes, the inguinal nodes should be treated and no, it should not be with short course. When the anal canal has to be treated, it is best to use long course chemo radiation because the following surgery the long-term bowel function is better according to patient reported outcomes from the UK national ...
What is your preferred IGRT approach when treating with ultra-hypofractionation for breast cancer?
If ultra-hypofractionated PBI, we do daily CBCT. If ultra-hypofractionated WBI, we do ports once during course. Exception is if we use an SIB boost. Also, regardless of laterality, we use DIBH for ultra-hypofractionated PBI and WBI.
For a cervical cancer patient who had involved para-aortic lymph nodes, how much higher do you extend the superior edge of your field if there are nodes close to the renal vessels (i.e. usual superior extend of field)?
In this dataset from us, next station was retrocrural nodes with involvement more than 25% and for that reason, we extend CTV for 2-3 cm above renal vessel to include retrocrural nodal region and space.Kabolizadeh et al., PMID 23849691
How do you manage osteonecrosis and pelvic insufficiency fractures after pelvic radiotherapy?
I have never seen osteoradionecrosis happen before in the pelvis. It should not happen in the range of doses that are tolerable in the pelvis due to the constraints imposed by the sacral plexus and the luminal GI organs. Sacral insufficiency fractures happen uncommonly, but are more common in female...
How do you manage TTFields for a patient with glioblastoma in the setting of disease progression?
Continuation of Tumor Treating Field (TTF) therapy at progression is an individualized decision for each patient.In the EF-14 trial upon which TTF was approved for newly diagnosed GBM after chemoradiotherapy, TTF was able to be continued until second progression. In this study, 18% more patients wer...
How are you using circulating tumor DNA in your clinical decisions for HPV-associated OPSCC?
We have a post-operative trial where we are using cfDNA as an integral marker to decide on adjuvant therapy for HPV+ OPC.
What is your approach to patients with unresectable, node-negative perihilar cholangiocarcinoma who have undergone biliary stenting and have no evidence of distant disease?
For perihilar cholangiocarcinoma that has been deemed unresectable by hepatobiliary surgeons, a good consideration is to have the patient evaluated for liver transplantation. The Mayo Clinic protocol allows tumor mass of <3cm, no nodal disease, and vascular involvement is allowed. Depending on the f...