Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you ever recommend radiation alone for a T1N0 anal cancer?
The standard of care for almost all anal cancers (even small node negative tumors) is concurrent chemoradiation, as it is associated with a better colostomy free survival and disease free survival compared to treatment with RT alone. There is a retrospective study showing a 2 fold increase in loco-r...
Would you ever treat the internal mammary lymph nodes in a high risk patient who is axillary sentinel lymph node negative?
I would consider in a high risk node negative patient- ex. age < 40, ER-/Triple negative, LVSI + with inner quadrant disease. However, I would look at dosimetry achieved and only include if I can meet both IM coverage constraints and heart and lung constraints.
Would you ever start radiation in the middle of cycle 1 of chemotherapy for LS-SCLC?
The goal is to get RT started early in the course, and to maximize the concurrent part of the therapy. But of course a patient only gets chemo for a few days per cycle, and we don't know whether the ‘concurrent’ effect is entirely due to those days treatment, or whether the radio-sensitizing effect ...
Do you routinely use hippocampal sparing techniques in the treatment of primary brain tumors?
The hypothesis of the hippocampus as an organ at risk centers on the exquisite radiosensitivity of neuro-regnerative stem cells located within the hippocampal dentate gyrus and important for memory formation. Pending results from NRG CC001, a recently completed phase III trial of whole-brain radiot...
Does the location of tissue expander and implant (pre-pectoral vs post-pectoral) have any impact on outcomes in patients treated with postmastectomy radiation?
At this time, there are limited data comparing outcomes between the two techniques. However, a recent publication did review radiation challenges with the change in technique and use of pre-pectoral implants.As pre-pectoral implant procedures increase, careful attention to dosimetry must happen. In ...
Would you consider breast radiation in patients with atypical ductal hyperplasia bordering on low grade DCIS?
I would have it reviewed by pathologist as along with pathological features, size and number of ducts, which is used as feature to distinguish ADH from DCIS. That being said for these low grade small volume DCIS would favor surgical excision alone and no RT
Would you recommend axillary dissection for a patient with a clinically positive SCV or IMN node, who has a clinical CR to neoadjuvant chemo, but a positive SLNB?
My approach for this is to treat comprehensively with RT and boost any visible node/location where the prechemotherapy node existed and was not removed at surgery.
How do you counsel/treat a locally advanced Stage IIB cervix cancer while patient is 12 weeks pregnant?
This is individualized with discussion with patient about cancer outcomes with a delay of treatment vs. loss of pregnancy.
How do you time same-day chemotherapy and radiation for patients undergoing concurrent chemoRT?
A great question. It is similar to recipes for pasta sauce - with rare exception no matter how you make it, it's usually good. There are retrospective data which suggest that capecitabine is most effective one hour prior to RT. That is the ideal sequence. However, since it is prescribed q12 hours it...
What volume would you treat after solitary axillary nodal recurrence after previous lumpectomy in a breast cancer patient without prior radiotherapy?
There's no perfect answer, but in most circumstances, I would favor treating the whole breast as well. An axillary recurrence suggests that there is at least some risk in the residual lymphatics of the breast. In the modern era of planning, in most circumstances, the breast can be treated without ad...