Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What radiation dose/fractionation would you consider for palliation of an unresectable vulvar cancer that received previous definitive radiation therapy?
For patients with recurrence after definitive vulvar irradiation, surgery is the best option, if possible.If this is not possible, then the retreatment with radiation can only be palliative to reduce pain or bleeding. Depending upon the extent of recurrent disease - a dose of 3000cgy in 10 fractions...
How would you approach a patient with a 12 mm recurrence of the left implant-based breast reconstruction 17 years after her initial diagnosis?
You haven't indicated what prior Rx the patient has received. Assuming no prior RT, I would radiate the chest wall, probably skip the nodes, and add hormonal therapy again, depending on what she has received in the past.
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
I find the biggest gains come from having clear and consistent communication around patient identification and treatment planning. Aligning on what constitutes “high risk” — both for local recurrence and metastasis — and which patients truly fall into the very-high-risk category is essential. It’s c...
Is PMRT considered the standard of care in women with 1-3 positive axillary lymph nodes?
I come to this question with a somewhat different stance than we have traditionally thought. To me, the following things seem clear:1) In our modern randomized trials of PMRT (British Columbia and Danish 82b and c) there was no difference in the OS advantage of RT based on # of positive nodes (1-3 v...
Is it appropriate to consider ultra-hypofractionation for phyllodes tumors of the breast when adjuvant radiotherapy is indicated?
I have used moderate hypofractionation for patients with phyllodes tumors for whom the logistics of coming for conventional fractionation were too great. However, I agree with Dr. @Dr. First Last that there are no data yet supporting this for phyllodes tumors specifically. Further, the issue of whet...
How do you approach reirradiation in a patient who underwent breast-conserving surgery for recurrent breast cancer after initial lumpectomy and APBI?
There is very little data on this scenario, though with increasing numbers of patients opting for partial breast radiation, this will become a more common issue going forward. While mastectomy remains a standard option, many women will desire breast preservation, and we have seen several women treat...
Have the 10-year results from UK FAST-Forward presented at ESTRO 2025 impacted your practice with regard to patient selection?
I would consider our practice at Mayo as early adopters of ultra-hypofractionation for breast, largely driven by similar institutional trials for shorter courses and the patients we care for. As a result, we have pretty routinely offered 26 Gy/5 fraction whole breast RT since the 5-year follow-up wa...
In what circumstances would you offer axillary re-irradiation after salvage axillary dissection?
A study from many years ago found no further axillary recurrences in 4 patients who had gross total excision of axillary recurrences following initial breast-conserving therapy, including RT and axillary dissection, with a median follow-up of 28 months (Recht et al., PMID 2033433). However, there is...
Do you routinely offer PMRT for T3N0 breast cancer?
Yes, especially in young women. The Danish PMRT trial included T3N0 patients, and in the pre-menopausal group, there was a meaningful increase in overall survival (10-year actuarial survival 82% vs 70%, with vs without PMRT; Overgaard et al., PMID 9395428). Now, one can argue that this is an old ...
Is there data to support treating postoperative endometrial pelvic EBRT with a daily dilator in the vaginal canal?
Data is more for GI malignancies on using a vaginal dilator to reduce dose to the anterior vaginal wall and thus the risk of stenosis. With the vagina being a target for endometrial cancer, there is no study using it during RT to show any benefit.Arzola et al., PMID 37898354