Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you add an adjuvant bone-modifying agent in patients with history of localized breast cancer?
In my opinion this is controversial question. The meta-analysis performed by EBCTG 2016 of over 11,000 post-menopausal women, and over 6000 premenopausal women, clearly shows a benefit for the postmenopausal subset. The absolute overall survival improvement was 3.3% (p=0.002) for postmenopausal wome...
How would you approach treatment in recurrent, localized rectal mucinous adenocarcinoma?
Well-differentiated mucinous rectal adenocarcinoma is relatively treatment resistant. In general if there is an in-field local recurrence after prior radiation (ie: is not a marginal miss), then that is very good evidence that it is radiation resistant. There are many studies now showing that re-irr...
What dose do you try to keep the contralateral breast when treating a PMRT inflammatory breast cancer that is extending across midline?
I agree with @Dr. First Last. In fact the medial portion of the contralateral breast (or chest wall if a contralateral mastectomy was pursued) may even be considered part of the clinical target volume if gross disease present at diagnosis actually extended past midline. Given the spread of inflammat...
Can you skip elective inguinal treatment in PET negative squamous cell carcinoma of anal canal?
This is an interesting question. There are a few small series that suggest that the negative predictive value of a PET-CT may be quite high (100% in the study by Mistrangelo, IJROBP, 2012). However, the gold standard in these results was sentinel lymph node biopsy, not inguinal lymph node dissection...
Can bicalutamide be used instead of LHRH agonist in intermediate to high risk prostate patients receiving EBRT who want to preserve erectile function?
The short answer is yes, BUT with some serious reservations: 1. This is not considered standard of care in this patient population, so patients should be made aware of that fact and that conversation should be documented in the medical record; 2. There are data to indicate that bicalutamide plus EBR...
How do you counsel patients on multivitamin use during therapy?
I tell patients to stop intake of anti-oxidant multivitamins (A,C and E) at the time of consultation, and if they so wish, they can resume them no sooner than 6-8 weeks after course completion because "radiation continues to work after we're done." I simplify how radiation attacks/kills the cancer D...
What do you consider to be the regional nodal bed for a Merkel cell carcinoma of the thigh with a positive sentinel node in the inguinal chain?
There's no clear right or wrong answer here - I would favor treating the superficial and deep inguinal nodes, capturing the chain as it extends superiorly and inferiorly with a generous margin above and below the site of the sentinel node. I would probably include the external iliac nodes if this co...
How would you treat a large-cell neuroendocrine carcinoma of the breast with bulky axillary involvement with good response to neoadjuvant chemo followed by mastectomy/ALND?
I would favor comprehensive treatment as uncommon disease and has poor outcome and would err on side of over treatment
What volume would you cover for HPV-positive SCC of level IB node with ECE?
Depending on the subsite and stage of the primary tumor and nodal stage, we may treat ipsilateral IB, II-IV and contralateral II-IV. We may need to cover IV if there is more extensive nodal involvement in the neck. But if we focus the question narrowly on IB node with met HPV(+) tumor with ENE, for ...
Would you ever recommend PMRT to the chest wall alone without nodal radiation for invasive or in situ breast disease?
In patients who are node negative upfront, I do offer PMRT for adverse primary tumor factors which meets criteria for PMRT to CW only. Retrospective data suggest majority of local recurrence in CW in these pts and can skip RNI