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?
How would you approach the parotid volume for a PET avid intra-parotid node when planning definitive chemo radiation for a locally advanced squamous cell carcinoma of the oropharynx?
Beware Warthin’s tumor! I have a low threshold to biopsy given the quite small (but of course not zero) risk of parotid metastasis in the typical patient.
Would you include interconnecting skin in the radiation volume for a patient with lateral forehead squamous cell carcinoma who will receive radiation to the surgical bed and preauricular lymph nodes?
Yes. It's the interconnecting in-transit lymphatics rather than the skin that is the actual target. Since these are very superficial, an electron field would do the job.
Would you consider palliative radiation for a bone metastasis while patient is on pembrolizumab and axinitib?
If the dose to the hollow organs (in this case, the esophagus) is low, it should be OK to give axitinib (with anti-angiogenetic property) concurrently with RT. If the amount of lung exposed to radiation is small, it should be safe to give pembro (risk of pneumonitis) together. The above comments are...