Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What rates of hemorrhage do you quote to patients receiving SRS/fSRT to intact brain metastases?
I have not had very many patients develop a hemorrhage into a brain metastasis treated with SRS. And those that have hemorrhaged probably had a tendency to do that with their initial presentation with brain metastases. And these hemorrhagic brain metastases have a higher incidence of symptomatic pre...
What CTV expansion volumes would you recommend for a large, unresectable, symptomatic desmoid tumor of the neck?
I would be generous. 2 cm. I’m heavily influenced by "don’t miss and don’t underdose". I appreciate the risk of collateral damage and follow my patients indefinitely, now up to 42 years.😳 I’m acutely aware of the major complications I’ve caused and the recurrences I might have prevented. A difficult...
How do you approach subsequent WBRT following prior brainstem SRS/fSRT?
So I’m assuming this patient who now needs WBRT after SRS for brainstem mets needs it because of elsewhere recurrence. Frankly, I don’t really have a WBRT constraint and ideally, the SRS was over 6 months ago but if the patient needs WBRT I would proceed. I would discuss the potential risk of radion...
Do you have a goal isodose line coverage for skin in the setting of post mastectomy RT with expanders in place?
I don't have a separate goal for skin dose per se in these cases; I primarily look at coverage. In terms of skin dose for these case, I only worry when there are features concerning for skin recurrence and when using higher energy photons.
Is postoperative radiotherapy indicated for a primary parotid gland melanoma?
Yes. I suspect that it would be a nodal met from an unknown primary. Surgery and postop RT.
How would you treat a bulky axillary squamous cell carcinoma of unknown primary in an elderly person?
70 Gy/ 35 fractions over 30-35 treatment days. Electively treat remainder of the axilla and supraclav to 56 Gy at 1.6 Gy per fraction SIB.
What dose of consolidative EBRT do you use after IORT for breast?
I look at these as two types of cases: 1. Planned IORT as boost: ex. younger patient with features warranting a boost who may be having oncoplastic surgery. I will post-operatively give 40.05/15 to the whole. 2. Planned IORT as monotherapy with high risk pathology: if positive margins, I discuss re-...
Do you utilize EUS to determine the nodal radiation fields in esophageal adenocarcinoma?
Assuming that the primary lesion is PET avid, I would not hold up therapy for EUS. If the patient clearly needs to be treated for locally advanced disease, the only question is whether the fields need to be modified. EUS is better than CT (or PET CT) in determining the precise T-stage, especially fo...
Does p16 negative status of anal squamous cell carcinomas affect your treatment approach?
While data are clear that being P16 negative is a poor prognostic sign, we do not have any data on how to alter treatment for these patients. Therefore, I do not change management based on P16 status.
When do you offer hyperbaric oxygen therapy to a pediatric brain tumor patient with radiation injury/necrosis?
I really think it depends as much on the clinical setting as it does the imaging appearance. If you have a case where you are on the early end of the timeline for a CNS RN event (i.e. 3-4 mo post-RT) and the patient is high risk (due to location dose, re-RT, concurrent chemo, etc), then it's worth c...