Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your treatment approach to radiation-induced meningiomas?
There is an unambiguous relationship between ionizing radiation and meningioma, the most commonly reported radiation-associated neoplasm [1,2]. It is thus perhaps curious that radiation therapy (RT) is 1 of the only 2 definitive management options for meningioma in the current era. Systemic therapie...
What techniques do you typically use for a photon breast boost?
Depends on the location of the cavity and depth, and breast anatomy. Mini tangents work well but can have a lot of doses beyond boost volumes. I sometimes will use a 3 field approach with a lightly waited anterior electron/photon field depending on the depth of the cavity.
Is there a role for post operative elective nodal irradiation in locally advanced sinonasal, clinically N0, intestinal type adenocarcinoma (ITAC)?
While I agree with Dr. @Dr. First Last's reply regarding post-operative ENI for high-risk sinonasal malignancies, I would like to offer a few points about treatment technique: Historically, treatment with conformal RT for localized malignancy at paranasal sinus (PNS) or nasal fossa would involve ort...
How would you manage newly diagnosed spinal cord compression presenting with paraplegia without tissue confirmation?
How do you approach the pharmacologic management of cancer-related fatigue?
After the above considerations mentioned in the question, management considerations regarding cancer-related fatigue depend on the stage of disease (advanced/metastatic disease vs not) and whether the patient is on active cancer therapy. For both groups, non-pharmacologic interventions have the high...
Based on the SENTINA trial, is it reasonable to allow for axillary assessment via SLNB alone (without axillary dissection) after neoadjuvant chemotherapy for an upfront clinically node-positive patient?
False-negative is reduced to 5% or low with dual tracer, taking more than two sentinel nodes out and making sure bx positive node is clipped, localized, and taken out.
How would you treat a skull based chordoma in a pediatric patient?
In a patient treated with peri-operative chemotherapy via the MAGIC regimen for gastric cancer who has a locoregional relapse in unresectable celiac node, how would you approach radiation treatment?
I would give an ablative dose to the node. These nodes are usually not near GI structures. I would electively treat the PA, portal, and splenic artery nodes with a microscopic dose at least down to the level of the IMA. I would not electively treat the remnant in the salvage setting. Dose options d...
How would you approach definitive chemoradiation for node positive anal cancer with a history of ulcerative colitis status-post total proctocolectomy?
If there is no recent history of active colitis I do not change anything. If there is colitis with an intact rectum, I reduce the radiation dose by 10%. The toxicity and consequences of APR are worse than the toxicity of chemoradiation.
How long would you wait after palliative short course radiation (i.e. 30Gy / 10 fractions) in metastatic NSCLC before initiation of chemo-immunotherapy?
I haven't typically waited for a specific period after short courses of palliative radiotherapy to start chemo-immunotherapy, if the patient has recovered from side effects from radiotherapy and is ready to start systemic therapy otherwise. Hopefully, data from studies and trials to better inform us...