Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you rather start radiation for Stage III NSCLC in the middle of a chemotherapy cycle or wait for the 2nd cycle if it could not be started on cycle 1 day 1?
While we all strive to provide streamlined multidisciplinary care, it may not always be possible to start at the same time. I usually discuss this with my collaborating radiation oncology physician. I usually like to time the radiation on D1 for logistical reasons. RT treatments for stage 3 disease ...
If you are treating a patient with palliative radiation for hemoptysis do you require chemotherapy to be held?
This is an interesting question. I would like to thank @Dr. First Last for his help with this. In recent years, I have rarely found myself asking colleagues from Medical Oncology to hold chemotherapy for patients who require palliative radiotherapy for hemoptysis. That being said, very few such pati...
How would you approach treatment of a posterior fossa metastasis with surrounding vasogenic edema causing mass effect on the 4th ventricle in an asymptomatic patient?
Agree with Dr Chao's answer above on this. In our institution, our treatment of these lesions (in the context of limited mets and no LMD) falls into 3 categories: -preop SRS, usually 15Gy/1fx to the lesion followed by resection that day, sometimes followed by post-op SRS if lesion still felt to be h...
Is it reasonable to only treat the inguinal nodes and not the pelvic nodes in an unresectable cT1cN0 vulvar SCC at the clitoris?
If lesion is superficial one can but if thick lesion based on drainage pattern would favor both inguinal region and lower pelvic nodes
How do you manage acute esophagitis that persists > 1-2 months after completing chemoradiation for lung cancer?
Harsh protracted esophagitis was reported in 4% of Int. O139(1999)i.e., grade 4 regardless of once or twice daily cycle 1 concurrent. CONVERT reports 18% grade 3!or higher, either QD 66 or BID 45. No reports of > 1 mo duration. Consider endoscopy and culture. Empiric carafate and anti-fungal/candida...
In what situation, if any, would you combine immunotherapy concurrently with radiation for patients with head and neck cancer?
In the definitive setting I would only use this combination in the setting of a clinical trial. In the recurrent/metastatic setting would consider for patients in need of palliation or with progression in a limited number of sites (with good responses elsewhere). I would prefer this be done on proto...
In what scenario, if any, would you treat a unilateral neck (vs. bilateral neck) for post-operative oral cavity (in historically midline structures such as oral tongue, FOM etc) SCC patients?
For midline oral cavity structures I always treat bilateral necks. This is true even for well lateralized oral tongue cancers. There is a very rich lymphatic network for oral tongue and floor of mouth and involvement of level 4 while skipping levels 1-3 on the ipsilateral side as well as contralater...
Based on the SENTINA trial, is it reasonable to allow for axillary assessment via SLNB alone (without axillary dissection) after neoadjuvant chemotherapy for an upfront clinically node-positive patient?
False-negative is reduced to 5% or low with dual tracer, taking more than two sentinel nodes out and making sure bx positive node is clipped, localized, and taken out.
How would you treat a skull based chordoma in a pediatric patient?
How would you approach definitive chemoradiation for node positive anal cancer with a history of ulcerative colitis status-post total proctocolectomy?
If there is no recent history of active colitis I do not change anything. If there is colitis with an intact rectum, I reduce the radiation dose by 10%. The toxicity and consequences of APR are worse than the toxicity of chemoradiation.