Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What would be your recommended target volume for a high-risk head and neck cutaneous squamous cell carcinoma with microscopic (not clinical) perineural invasion and negative sentinel node biopsy?
That is a good question. Our pathologist takes perineural involvement one level further by describing the nerve involvement as either being small or large nerves. If small cutaneous nerves are involved I make certain that my margins are at least 1.5 cm beyond the clinical tumor margin. If a large ne...
Would you recommend local therapy for a residual breast tumor after chemotherapy following CR of distant disease in a patient with metastatic disease?
Palliation is one clear indication for treating a primary breast tumor in a patient with metastatic disease and may be considered if the tumor is fungating, painful, and/or bleeding. The second potential indication, which is likely the intent of your question, is to improve long term disease control...
How would you treat a patient with a refractory primary splenic marginal zone lymphoma with symptomatic splenomegaly (20 cm) and a mild pancytopenia?
Radiation therapy is utilized in two primary settings to palliate symptoms of splenomegaly in patients with hematologic malignancies.First, extramedullary hematopoiesis within the spleen can lead to symptomatic splenomegaly in a variety of hematologic malignancies (e.g., myelofibrosis). In this sett...
Are there local control and/or toxicity differences between multi-catheter interstitial versus balloon catheter techniques for APBI?
There are no randomized comparisons to guide local control outcomes between the two. That being said the local control rates are comparable in series evaluating interstitial (Hungarian trial, GEC-ESTRO) and prospective balloon/applicator (MammoSite Registry). B39 allowed for both but no data has bee...
How do you prevent non-healing ulcer when treating patients with cutaneous SCC of the distal lower extremity who have peripheral vascular disease?
@Dr. First Last points are well taken but he does not mention dose fractionation. For most skin cancers, I usually treated with a fairly short course of RT , e.g. 400×10, but not in this situation, where a longer course, e.g. 60-70 Gy in 2 Gy fxs may be desirable.
Is it acceptable to omit post-lumpectomy radiation in an elderly patient with recurrent, ipsilateral breast cancer but low risk features?
In terms of omitting post-lumpectomy radiation, its about assessing risk. If this is a recurrence in the same area or proximity ("true recurrence"), I would consider RT in light of recurrence particularly if time from original diagnosis was short. If this was a recurrence in another quadrant or dist...
What is your recommended surveillance imaging routine for a patient with an esthesioneuroblastoma following adjuvant radiation?
My surveillance strategy is: First followup PET and MRI at around 4 months. Follow up with HN surgery and rad onc every 4 months. Repeat imaging at 6 months. Repeat imaging yearly or if needed.
How would you manage a localized stage IV squamous cell carcinoma of vagina involving the posterior vaginal wall and full thickness of the anterior rectal wall?
I would get staging scans including PET and MRI and plan for definitive chemo RT with a final boost, most likely with IMRT, to 66 to 70 Gy.
Would you offer regional nodal irradiation for cN1 breast cancer patients who undergo neoadjuvant chemotherapy and experience a complete nodal response?
This issue frequently comes up in patients where there appears to be equipoise in treating or not treating the regional nodes in breast conserving therapy (or offering post-mastectomy chest wall and regional nodes in mastectomy patients) with a complete pathologic response or conversion to node nega...
Would you deliver SBRT to the adrenal gland if a patient has already undergone contralateral adrenalectomy for oligometastatic NSCLC?
I have treated one patient in a similar scenario, with bilateral adrenal metastases. I referred the patient to endocrinology for counseling about the need for future adrenal hormone replacement, and after thoroughly discussing these implications with the patient, we proceeded. This is of course an e...