Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your experience and practice patterns when treating midline NUT carcinoma of the head and neck?
Of the neuroendocrine HN cancers, NUT cancers are very rare undifferentiated or poorly differentiated squamous cell carcinoma defined by rearrangement of the NUTM1 (aka NUT) gene. Due to the rarity of this disease, published reviews include mostly assortments of case reports with conflicting results...
How do you manage a symptomatic meningioma and associated vasogenic edema in a poor performance status patient?
Superficially, this resembles a straightforward question, but in reality, it is very nuanced, with numerous variables driving decision-making. My sequential "thought-experiment" in a situation like this would proceed as follows:1. Why does the patient have poor KPS? Are there underlying comorbiditie...
Would you offer adjuvant chemoRT to a patient who underwent neck dissection for a T0N1M0, p16+ head and neck squamous cell carcinoma?
Yes. At least the RT. Chemo would depend on the extent of neck disease. Multiple nodes and/or level 4, add chemo.
Would you consider salvage RT in a prostate cancer patient with controlled Crohns disease?
In my experience, I have now treated two patients with Crohn's with definitive (not adjuvant/salvage) EBRT. Both had quiescent disease for years, clinically and endoscopically/pathologically, and were not on any pharmacotherapy. Both tolerated treatment well with no acute/late toxicities. One was ve...
Would you consider PMRT for non-mass like enhancement >5cm on breast MRI that resolves with NAC and has a pCR?
For clinical T3No with pCR, limited data suggest low risk of LRR and I usually avoid PMRT unless triple negative or multiple adverse factors on pretreatment pathology and imaging.
How do you approach management of newly diagnosed locally advanced NSCLC in patients who are intubated for respiratory failure due to their disease burden?
There are a few other approaches that can sometimes help: Interventional pulmonology can sometimes debulk tumor in the airway and/or place a stent. I've had some success with intrabronchial brachytherapy as well. I've had more success with 1-3 relatively large radiation fractions (4-6Gy). However,...
When treating early stage rectal cancer (T1-2N0) with neoadjuvant long course CRT with the goal of downstaging for sphincter preserving surgery, do you reduce your radiation volumes to spare toxicity?
Trans anal excision should be feasible for T1N0 without preop RX. Preop chemoRT plus trans anal excision should be suitable for T2N0. Would not recommend long course induction chemotherapy.
Would you electively cover the neck for intermediate grade mucoepidermoid carcinoma of the salivary gland?
I cover the level II and upper level III nodes in these cases. These are essentially already covered in the field when treating the parotid bed and surgical scar in most cases. It does not increase the volume by a lot when including these elective nodal regions.
How do you approach salvage for a local/marginal failure after IR ablation for medically inoperable stage I NSCLC?
Local/marginal failure after IR ablation can be salvaged with SBRT depending on the location and imaging. Since IR ablation is not commonly done in primary lung cancer, we don't have a lot of information on using SBRT in this situation. The dose and fractionation will depend on the location and prox...
How would you manage a patient who had salvage prostatectomy after cryotherapy failure and now has a rising PSA?
I would approach the decision to treat this case similarly to if the patient had never had cryo, counseling the patient that the risk of toxicity may potentially be somewhat higher.