Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider telomeropathies as an absolute contraindication to radiation therapy?
No, but it's very relevant to discuss the implications of RT when there is an indication for radiotherapy when consenting a patient.Many telomeropathies are subclinical/under-diagnosed due to variability in the clinical phenotype (Walsh et al., Clin Cancer Res 2017), but there are clear data both fr...
What do you consider a curative radiation dose for a sarcoma?
This is a difficult predicament. We would certainly try to re-resect if at all possible; if not, a consideration could always be made for an amputation, but we try to avoid this if at all possible. Other options during the time of resection are consideration for brachytherapy. We would also discuss ...
Is it acceptable to deliver ablative hypofractionated radiation therapy for unresectable intrahepatic cholangiocarcoma in conjunction with concurrent checkpoint inhibitor?
There are safety data from MGH with single agent checkpoint inhibition (from @Dr. First Last) that demonstrate the combination is safe. The only concern I would have would be if you were starting both at the same time and the TAAs started to rise. You would not be able to discern toxicity from the d...
How would you approach a new solitary sternal metastasis for a triple positive breast cancer 1 year after hypofractionated breast radiation?
These are increasingly common scenarios in our practices. The first step would be systemic staging to ensure that this is a solitary metastatic site or there is limited metastatic disease. I would have the patient evaluated by medical oncology to discuss systemic therapy options for this triple posi...
How do you manage symptomatic brain metastases from small cell lung cancer?
I would like to know pertinent information including the following: age of the patient, performance status, prior whole brain radiotherapy (WBRT) or prophylactic cranial irradiation (PCI) history, systemic therapy the patient received or is receiving, size of this suspected symptomatic brain metasta...
What radiation sensitizer do you recommend for early stage poorly differentiated squamous cell carcinoma of the anus, in a patient with stage IV chronic kidney disease?
I have used carboplatin (AUC 2 weekly) + 5-fluorouracil in this setting with good tolerance. I acknowledge that the substitution of carboplatin for cisplatin is largely an extrapolation from the approach to squamous cell carcinomas of other primary sites. However, I feel very comfortable with this s...
How would you treat maxillary ameloblastic carcinoma s/p R1 resection and perineural invasion?
Treat like a squamous cell carcinoma. 66-70 Gy at 2 Gy per fraction. Treat to the skull base. Consider protons depending proximity to visual apparatus. Electively treat the neck.
What dose and fractionation would you use for definitive intent radiation therapy for a metastatic melanoma of the maxillary sinus?
Paranasal sinuses (PNS) are common sites for primary mucosal melanoma of the H&N, which is itself a rare entity in comparison with their cutaneous counterpart but of even more aggressive nature. Thus, I wonder if this is actually not a metastatic setting you're facing. Even if there were other melan...
Would you stop hydroxyurea for thrombocytosis in a prostate patient receiving radiation?
In cervical cancer literature, when hydroxyurea was used with RT as a radiosensitizer, acute side effects were significantly increased, including myelosuppression. I would consider holding it during RT.
How would you approach an unresectable locally advanced lung cancer invading the chest wall 25 years after whole breast radiotherapy to the same side?
The first thing to evaluate is the location of the current tumor and treatment fields for previous breast radiation. It's unlikely to get a full treatment plan, but if you can get dose, fields, and if you are lucky, some kind of field set up, you might be able to "recreate fields". If it was whole b...