Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In LS-SCLC, for a patient with positive mediastinal LN but PET negative ipsilateral hilum, would you treat the hilum?
I generally agree with Dr. @Dr. First Last, however, it would depend on the location of the primary tumor. If the dose to the primary treated part of the hilum, I would treat the hilum more comprehensively. This just because it would be so difficult to go back should the tumor fail there. I agree th...
For a breast plan utilizing a medial electron patch for comprehensive nodal coverage, do you have a limit for hot spot at the electron photon match?
We match at skin rather than at depth and feather junction once or twice depending on fraction number to reduce hot spot size and volume.
How would you (non-surgically) approach and treat two synchronous distinct oropharynx T1-T2N0 primaries with definitive RT?
RT to oropharynx and bilateral neck. I can’t imagine that both are lateralized to one side. If so, one cancer. No chemo.
How would you manage a papillary thyroid carcinoma incidentally found on planning CT for T1 glottic cancer?
Treat the glottis with RT 63 Gy/28 fractions and then operate the thyroid.
Would you ever offer adjuvant immunotherapy after definitive chemoradiation for esophageal cancer?
A great question – one that we really don’t have data to answer quite yet. Obviously, we do have guidance for resectable patients. CheckMate 577 was a randomized, double-blind, placebo-controlled phase 3 trial in patients with stage II or III esophageal or gastroesophageal cancer who received neoadj...
Is there evidence to justify the recommended anterior margin for post-prostatectomy radiation to the pubic bone?
In my opinion, the answer to this question is no. When one looks at sites of recurrence using more modern imaging, especially mpMRI, the most common sites of non-nodal recurrence are around the vesicourethral anastamosis and along the posterior bladder wall near the seminal vesicle remnant. Extendin...
What treatment would you offer a patient who underwent surgery for an extrahepatic cholangiocarcinoma and subsequently developed an isolated malignant biliary stricture?
In this case, for an isolated bile duct recurrence, local radiation therapy can be considered. It would be preferred over systemic therapy as radiation therapy can provide long term disease control. The case would have to be discussed with the radiation oncologist regarding feasibility and type and ...
How would you manage a patient with a growing central liver metastasis previously treated with SBRT who is ineligible for chemotherapy?
This is a challenging scenario for which there is no quick/easy solution. My initial assessment would involve obtaining a further understanding of the patient’s performance status/disease course/biology (is this an isolated site of recurrence vs polymetastatic progressive disease), prior SBRT dose a...
How would you manage a patient with locally advanced rectal cancer with an ileal conduit?
I don't claim to have extensive experience treating these, but I do still recommend the standard of care treatment of neoadjuvant chemoradiation for LARC patients with ileal conduits. I've made sure to keep the ileal conduit to small bowel tolerance doses, using IMRT to avoid as much as possible exp...
How would you manage a patient with a 2 cm forehead subcutaneous lesion s/p excision found to be a diffuse large B-cell lymphoma germinal center?
If this was known to be a DLBCL before the excision, the patient would have been recommended some variety of R-CHOP x3-4 +/- consolidative RT, given that it appears low risk IE and would've been eligible for the LYSA RCT (Lamy et al., PMID 29061568) showing only small PFS benefit (non-significant) o...