Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a recurrent mediastinal node 2 years after 45Gy BID to this region with combined chemotherapy for SCLC in patient no longer tolerating systemic therapy?
If comprehensive restaging (PET, Chest CT with IV contrast, brain MRI) demonstrated a single biopsy proven nodal recurrence 2 years after standard chemo-XRT, I would retreat the patient. The critical structures are likely to be the trachea (tolerance dose ~90Gy) and the esophagus. There has been som...
For patients with p16+ SCC of a cervical lymph node subsequently found to have an oropharyngeal mass on imaging, is it necessary to biopsy the primary site prior to proceeding with definitive RT?
No. When it gallops like a horse, there's no need to think of a zebra - unless you're in wild Africa. And if the patient had presented with biopsy-proven p16+ neck node metastatic SqCC with "unknown primary" while a PET/CT showed suspicious uptake at the oropharynx, one should treat the presumed pri...
What role, if any, is there for Y90 in metastatic gallbladder cancer to the liver?
Radioembolization has been best studied in liver dominant metastatic colorectal cancer (mCRC) and BCLC Stage B hepatocellular carcinoma (HCC) as these are the two scenarios where there have been large randomized controlled trials of Y90 vs standard of care systemic therapy (SARAH and SIRveNIB trials...
When should proton beam therapy be considered for uveal melanoma?
When the tumor is identified as COMS large or the patient is not in favor of enucleation, and or plaque therapy is not feasible due to location. Tumors located in the back of the eye and under orbital muscles are difficult to treat with plaque without significant risk to the muscles or nerves. The s...
Would you approach a salvage case post prostatectomy differently in a patient with a piece of broken metallic surgical tool located in the prostate bed?
In this case where "a broken piece of surgical tool is located in the prostate fossa" in a patient who may now requires EBRT. My initial thoughts are: 1. Consider if there is any legal action ongoing or in the past regarding the case? 2. If no ongoing a past legal action referencing this matter, and...
Would you consider an axillary dissection in a young patient with high grade breast cancer and one sentinel LN with isolated tumor cells?
I agree with @Dr. First Last. Although young patients and high grade tumors were less common in ACOSOG Z0011, they were included in the study. There is no data to suggest that they fare any worse with standard adjuvant therapy alone versus ALND. I would proceed with radiation and systemic therapy in...
Do you recommend treating the entire extent of hardware for a femoral neck plasmacytoma with pathologic fracture requiring internal fixation?
Since radiotherapy is potentially curative for solitary plasmacytoma, the entire hardware should be covered. Although unusual, there is slightly increased failure when the full extent of hardware is not covered. See nice paper from MDAH on this issue: Elhammali et al., PMID 31133526. In palliative c...
Can over the counter mouth guards be used to reduce back scatter from dental fillings during head and neck radiation?
I have been using them for years for my H&N patients with success, in any patient with a metal capped tooth. I have never had a tongue or buccal mucosa ulcer when using them, except in a couple of cases where the fit was poor and I did not recognize this. Custom ones are expensive and are often not ...
Would you offer liver SBRT to a patient with a history of a liver transplant?
At the University of Michigan, we have offered SBRT for patients who have failed intrahepatically post liver transplant with no metastatic disease. The risk of relapse of HCC post transplant is 15-20%. There is an interesting score developed by UCSF (RETREAT; Mehta et al., JAMA Onc 2016) in which th...
Would you offer radiotherapy or chemotherapy a patient with cervical cancer s/p radical hysterectomy and now a delayed metastasis to the ovary that was completely resected without tumor spill?
I agree with everything said so far. Extremely rare situation. I suppose I would add that the devil is sometimes in the details. Age? How far out from hysterectomy? was the ovary large? Difficult dissection that might suggest disease left in adjacent tissues? Also important to check with the patholo...