Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach treatment of an optic glioma in an adult?
Optic gliomas, particularly the pilocytic variety (generally found in children) are very rare in adults (unless associated with NF1) and the literature is scanty (mostly case reports). The diagnosis is frequently delayed and therefore, significant visual loss is common at diagnosis. The histology is...
How would your elective nodal coverage change in a patient with anal cancer metastatic to a high external iliac node?
I agree with the comments above, but I have an additional comment. For some reason as a field, we have pushed the dose to electively treated regions to 45 Gy, although there are no data in the literature to justify that high a dose. I would extend the radiation fields to the celiac axis but would li...
For a cystic lung tumor <5cm, are there any special SBRT planning considerations that you consider as compared to a solid lung tumor?
I don't typically change much about SBRT planning for cystic lung tumors, besides being particularly cognizant of any interfraction changes on the CBCT. In my experience, I haven't yet noticed major differences in outcomes for these tumors. I am not familiar with literature specifically asking this ...
What is your approach to adjuvant radiation in SCC of oral cavity with exposed bone following mandibulectomy and reconstruction?
Wait up to 8 weeks (prefer 6), irradiate, and deal with bone later if still present.
How do you manage cancer treatment-related cognitive change or "chemo brain?"
Chemo-brain is a vexing and complicated diagnosis. In most cases, you don't know the baseline neurocognitive function of individuals with cancer. Many conditions that are associated with chemotherapy like fatigue, depression, and aging can mimic chemo-brain. Estimates are that about 20% of individua...
Does apocrine differentiation/AR positivity alter your radiation recommendations for triple negative breast cancer?
At present, we don’t treat these like low risk and offer adjuvant RT as no data on LR without RT.
How would you manage a patient with isolated metastatic high grade sarcoma to inguinal and external nodes in a patient with BRCA+ mutation?
Ovarian cancer treatments can work for BRCA2+ leiomyosarcoma.This has been published (Seligson et al., PMID 30541756) and I have had a couple of patients with BRCA2+ LMS. I had no luck with PARP inhibitors but one tremendous success with cisplatin, which produced a dramatic response in one heavily p...
Would you consider perioperative chemotherapy in an anastomotic recurrence of gastric cancer after partial gastrectomy who did not receive prior chemotherapy or radiation?
My practice is to treat this exactly like de novo locally advanced disease. This means that the patient needs to be carefully (re-)staged, including with PET/CT scan, possibly an EUS, and most importantly, a diagnostic laparoscopy. Recurrence at the anastomosis can certainly also be associated with ...
How do you manage a patient with isolated local recurrence of head and neck cancer with a pharyngocutaneous fistula within previously irradiated field?
Resection if feasible (unlikely) or palliatively.
If CBCT is not an option, what is your preferred IGRT strategy for prone breast patients?
We have never used CBCT for whole breast prone patients. Daily lateral MV is our standard approach + weekly ports. Could consider KV daily, as well.