Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient with cutaneous SCC of the lower extremity with isolated inguinal nodal involvement?
Good timing for this question, since I’m currently treating a similar case of Merkel Cell Carcinoma (MCC) on dorsal skin of wrist with isolated axillary nodal involvement. The same oncologic principles should apply for SqCC as well: As far as surgery is concerned, wide local excision (WLE) for the ...
Do you offer whole lung radiation with metastatic recurrence of Wilm's Tumor (FH, no LOH 1p16q)?
WLI should certainly be administered alongside salvage chemotherapy for metastatic recurrence. There are no definitive data on timing, but the earlier the better.See the relapse arm of NWTS-5 (Malogolowkin et al., PMID 17539021, Green et al., PMID 16547940) and AREN1921 for details regarding integra...
Would you offer adjuvant radiation for a grade 1 osteosarcoma of the mandilbe with close margins following surgical resection?
There is a good rationale for offering post-op RT in this setting. A relevant retrospective series from MDACC reported on ~120 patients who underwent surgery with or without RT (Guadagnolo et al., PMID 19382187). In this report, approximately 40% developed local recurrence, speaking to the high rate...
Do you offer adjuvant radiation therapy for sacral chordoma s/p gross total resection with close margins <0.5 cm?
Yes to adjuvant RT, but doses of 50-60 Gy have no benefit in chordoma. 70 Gy is required even with R0 margins. See Konieczkowski et al., PMID 32147017 for a full discussion of the literature.
How do you manage a cervical cancer that needs interstitial brachytherapy with prolonged thrombocytopenia after concurrent chemoRT?
Although infrequent, we have done pre op plt transfusion to make brachytherapy feasible and to avoid prolonging the total duration.
Is it essential to wait one week after loading dose of erbitux to start RT for head and neck cancer?
I would start RT if it means you're going to risk delaying RT start window. Another question is, why are you giving Erbitux for post-op treatment? Can you use another agent?
How do you do approach treatment of a recurrent gliosarcoma?
Primary gliosarcoma remains a challenging clinical conundrum. There are no curative therapies and little to no high level evidence to guide decision-making. Most approaches have followed patterns similar to those used for recurrent glioblastoma. The outcomes are usually poor. However, it does help, ...
Does microscopic ENE warrant post-mastectomy radiotherapy if all other factors are low risk?
With respect to ENE, I first look at axillary surgery. If the patient has SLN+ and microscopic ENE, I do typically offer PMRT even with other low-risk factors. While the IBCSG trial evaluates micrometastases, it's important to remember 90% received lumpectomy, and therefore, most received whole brea...
How do you approach treatment for a patient with uveal melanoma who is not a candidate for plaque brachytherapy
If plaque brachytherapy is not possible, we consider proton beam therapy to a dose of 50 Gy/5 fractions. Enucleation of the eye is the surgical alternative.
Is tumor deposit (N1c) alone an indication for adjuvant chemoRT for rectal cancer that did not receive neoadjuvant therapy?
Some patients such as this were undoubtedly included in the early rectal cancer trials [GITSG and Mayo North Central (NCCTG)] that established the role of post-operative chemoradiation for stage II and III rectal cancer. However, accrual numbers were too small for stratification of TN subsets and it...