Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer adjuvant radiation therapy for a Merkel cell carcinoma limited to the epidermis with close margins?
I would review this case with a dermatopathology expert before making any decisions. The reason is that normal Merkel cells usually lie in very close proximity to the basement membrane. My understanding is that a skin neoplasm that is limited to the epidermis does not broach the basement membrane, a...
How would you manage recurrent popliteal and inguinal LNs from melanoma?
1. Confirm no distant metastases. 2. Therapeutic lymphadenectomy if possible, followed by adjuvant lymph node basin radiotherapy, 48 Gy/20 fractions or equivalent in 2 Gy fractions. If BRAF altered, consider adjuvant dabrafenib/trametinib. If not BRAF altered, consider adjuvant ipilimumab. 3. If unr...
How would you define bulky involvement of the tonsil in a patient with DLBCL?
While the definition of "bulky" disease has been relatively consistent in the Hodgkin literature, the definition in prospective DLBCL trials has not. For example... ECOG 1484 - 10 cm SWOG 8736 & SWOG 0014 - 10 cm GELA 93-1 & 93-4 - 10 cm RICOVER-60 & RICOVER-noRTh - 7.5 cm UNFOLDER - 7.5 cm OPTIMAL>...
What are the current appropriate planning margins for Wilms tumor in lymph node negative cases?
I would recommend treating with the AREN1921 treatment volumes as these are the most updated version of the treatment guidelines. The block should extend 1cm beyond vertebral body. Always treat the entire LN chain.
How would you manage an incidentally identified 1.0 mm anal squamous cell carcinoma (5.5 mm margin) in a background of severe dysplasia/CIS involving the peripheral excision margins found on a hemorrhoidectomy specimen?
T1 anal margin cancers can be adequately treated with local surgical excision if negative margins (> 1cm) can be accomplished without compromise to the adjacent sphincter muscles and no evidence of nodal involvement. In this specific case, I would recommend thorough examination via anoscopy with bio...
How would you manage a recurrent endometrial cancer confined to the vaginal cuff that is completely resected?
At this point, unless there is contraindication to EBRT, we favor the combination of EBRT plus HDR brachy.
Would you recommend ISRT after salvage auto transplant for relapsed classical Hodgkin Lymphoma if the patient had Deauville 2 after ICEx2 prior to BEAM auto transplant and now has Deauville 1 imaging?
There are no randomized studies (to my knowledge) formally evaluating the role of consolidation RT in the setting of relapsed Hodgkin lymphoma (HL) and autologous stem cell transplantation (ASCT). Outcomes are universally worse in the salvage setting compared with upfront management. Therefore, it s...
What image guidance do you utilize for photon breast boost?
We usually use mV portal imaging.
Would you offer adjuvant radiation to a woman with a history of mastectomy and reconstruction for DCIS (no prior RT) who develops a cT1cN0 new primary IDC in the chest wall?
I would usually treat this recurrent/new primary with PMRT.
How would you treat superior sulcus NSCLC with small volume N2 disease?
The question of surgery for N2 NSCLC patients in light of current survival and LC rates in the modern RT era with immunotherapy remains unclear. Historically, for these superior sulcus NSCLC patients, surgery played a large role due to our inability to deliver adequate dose of RT because of proximit...