Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach the treatment of a low grade adnexal carcinoma of the scalp in a patient with prior history of WBRT as a child?
Post-op RT and RT alone for the second one, if surgery is not an option. No hypofractionation.
How would you manage the cavity of a resected anaplastic meningioma with pulmonary metastases?
Metastatic meningioma outside the CNS is rare, and its incidence has been estimated to be 0.1% with the lung being the most common site for distant metastases (Surov et al., PMID 23404622). There is no clear standard therapy for the management of metastatic meningioma. Suppose this was an anaplastic...
Is radiation therapy a treatment option for refractory Paget's disease of the vulva extending onto skin of buttocks and anal margin?
I have treated localized peri-anal Paget's Disease with good outcomes, and there is some data to support this. I have not treated a patient with such widespread vulvar Paget's and I suspect that the morbidity would be significant given the doses required, and the volume to be treated in the case you...
How would you manage RT for a locally advanced squamous cell carcinoma of the anal canal in a >90-year old if chemotherapy is not recommended?
For any elderly patient, a discussion of goals of care in the context of symptoms is warranted. In the chance this is a small asymptomatic cancer in a patient with limited life expectancy, no therapy may be reasonable. However, this does not seem to be the case for your patient.If the patient is dee...
How do you approach treatment of vulvar cancer with bulky lymph node metastasis?
PET CT. Plan definitive chemo (weekly cisplatinum) with IMRT, with a dose of about equivalent dose of 66 Gy to GTVs. Reassess after 6-8 weeks for excision or bx of any residual disease. Dose-Escalated Intensity Modulated Radiation Therapy in Patients with Locally Advanced Vulvar Cancer- Does It Incr...
What would be the recommended management for patients with rectal adenocarcinoma with rectovaginal fistula at presentation?
Diverting colostomy, preop RT chemo, and surgery.
How would you approach therapy in a young adult with synovial sarcoma of the head and neck who is not amenable to surgery due to location on the face?
I do not think primary synovial sarcoma is curable without surgery. I have never seen a durable response in a tumor treated with radiation alone. Synovial sarcoma responds to ifosfamide based chemotherapy generally, but in my experience, the response rates for primary tumors are lower than response ...
Would the diagnosis of skin-only morphea (localized scleroderma) alter treatment recommendations for localized anal cancer?
There is enough data about the acute and late toxicity from radiation in these patients to be concerned. However, none of it rises to the level of the toxicity of APR. Therefore, my approach would be to involve the patient in the decision, document, and reduce the dose by 10%.
How would you approach palliation of a symptomatic cervical cancer involving the supraclavicular lymph nodes?
Bx- to confirm. I would favor chemo first and if responds to chemo, plan for more definitive dose of RT and if no response, then palliative RT.
What is the role of RT for a patient with double-hit DLBCL and a single site of relapse who can no longer tolerate chemotherapy?
Double-hit DLBCL, now referred to by the WHO as "High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements" is an aggressive non-Hodgkin lymphoma. The MYC rearrangement results in accelerated growth of the lymphoma while a BCL2 rearrangement (more common than BCL6) results in an anti-a...