Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you give RT to an ulcerated resected T2 BCC of the perianal margin, with close margins, and no anal canal involvement?
No, this is a favorable histology with an extremely low nodal metastasis risk and nearly a 100% salvage rate with definitive radiation. Any long term toxicity would be hard to justify and could come with medicolegal vulnerability.
What dose and volume(s) would you consider for a young woman with an axillary nodal recurrence from breast cancer s/p TBI as well as chest wall (only) radiation?
I would consider RT to the undissected axilla and supraclavicular region and limit the dose to 45 Gy in 25.
Do you consider cystic fibrosis a contraindication to lung SBRT for primary NSCLC or oligometastases?
Just when you think you've done every odd thing in thoracic RT... I have never done RT on a patient with CF. The median survival, according to Dr. Google (advanced edition), is around 40 years which is most likely why I haven't seen that presentation. Double advanced Dr. Google (scholar.google.com) ...
Is extranodal extension of pN1 NSCLC an indication to offer PORT?
All PORT analyses that I know show no benefit to XRT in N1 cases, and worse survival in some. The “extension” outside tempts one to alter these facts and treat. I would ask about systemic treatment. I’d reserve XRT for exclusive local relapse. I would offer PORT for + margin or any N2.
How do you manage early rectal symptoms such as tenesmus in a patient undergoing pelvic radiation for prostate cancer?
If patients are having symptoms out of proportion to what you would expect, I consider other potential causes, especially if the usual management approaches aren't working. I've had a few patients over the years with undiagnosed Celiac disease, who got severe early diarrhea during a course of extern...
Are there any known bone marrow constraints that should be utilized for prostate IMRT?
We do not contour the bones/marrow for standard prostate patients here, nor have I seen this specified in prostate RT trial protocols. Extrapolating from gyn trials would be reasonable, but I tend to think of those marrow constraints as more important for patients getting cytotoxic chemotherapy, whi...
How would you manage a woman with recurrent Paget's disease of the vulva, s/p resection, with most recent pathology showing multiple foci of early invasion?
I would consider assessing for sentinel node because of invasion. Adjuvant RT, if margin is close and/or positive only.
Do you constrain dose to the muscles of mastication in definitive and/or post-op HN RT to lower the risk of trismus?
I don't know of any published data on constraints for masseter or pterygoid. While we are on this topic, DARS - a phase III randomised multicentre study of dysphagia- optimised (Do-IMRT) versus S-IMRT in head and neck cancer showed improved swallowing with sparing of constrictor muscles and should b...
What dose-fractionation would you recommend using for a locally advanced, ulcerated squamous cell carcinoma resulting in a non-healing wound in the setting of multiple prior surgeries, flap reconstruction, and baseline immunosuppression?
I have encountered a few similar cases of ulcerated tumors, mostly advanced skin cancers. If non-resectable, full-dose standard chemo-RT; if successful in eradicating the tumor, will result in healing of the wound over time.
How would you manage a small recurrent melanoma of the lower eyelid in a patient deemed inoperable?
RT. 70Gy/35 fractions or its equivalent with orthovoltage, which I would prefer.