Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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.
What makes a daily huddle successful?
Intention of a daily huddle is to quickly make the team aware of issues either seen yesterday needing attention, and anticipating such issues today, identifying other outlier events or variations impacting your team/department, and brief review of the day (e.g. staff changes, coverage, special proce...
How should a patient with perforated H. pylori negative gastric MALT be managed?
Generally, the treatment for H. Pylori neg gastric MALT of limited stage is radiotherapy, dose 24-30 gy. The question presumably concerns the influence of a history of perforation on that recommendation. Data are limited but radiation induced gastric or intestinal perforation when treating lymphoma ...
When you treat postop head and neck cancer, do you typically add a CTV margin to the delineated postoperative bed, or just treat postop bed plus PTV margin?
We don't ever have a CTV margin. It is postop bed which accounts for all pre-surgery GTV and all postoperative changes on imaging, also review the op note and path. We then add a 3-5mm margin to account for set-up.
Would SBRT be recommended for a non-surgical isolated para-aortic recurrence in the setting of metastatic papillary serous ovarian cancer residual disease after systemic therapy?
There are multiple retrospective single institution and combined multi institutions studies showing RT in this setting (either SBRT or regional IMRT based on clinical scenario and nodal recurrence pattern) leads to excellent index cancer control. It prolongs chemotherapy free interval and progressio...
How do you manage muscle pain and irritation due to radiation?
I manage the pain control with steroids.