Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach a BRAF negative metastatic melanoma patient on immune checkpoint inhibitor therapy with enlarging, symptomatic brain lesions that had previously been treated with SRS?
Depending on the PS and medical history of the patient, would recommend moving them to ipi (3 mg/kg)/nivo (1 mg/kg) as soon as possible. - Brent Hanks
Is there a role for external radiation and/or brachytherapy in stage IVB vaginal cancer aside from palliation?
I would offer palliative RT. Quad shot to the site of symptomatic disease (primary and gross node).
Would you offer definitive radiation therapy for a Merkel cell carcinoma in which surgical resection would be disfiguring or result in significant dysfunction?
I would, but after an appropriate discussion. First, I favor full staging of all Merkel cell patients with a PET/CT (though many would argue this is not mandatory for small tumor, node-negative patients). I would also recommend a sentinel node procedure because the risk of nodal disease is significa...
Can the inguinal and pelvic nodal RT be omitted for FIGO IVA unresectable vulvar cancer with a negative bilateral inguinal nodal dissection?
In my opinion, the answer is a qualified "yes." Has the patient had a PET scan that is negative, except for the primary vulvar lesion? If so, this argues in favor of omitting inguinal and pelvic LN's since the negative predictive value of PET for adenopathy in gyn cancers is consistently reported to...
What kidney constraints would you use for a patient with horseshoe kidney?
It depends on the clinical scenario (treating pa region prophylactic or definitive). If prophylactic, then be more conservative and plan for a mean dose of less than 10 Gy (16 Gy volume to less than 5 percent). If gross disease around, then the mean dose can be higher but try to focus on the highest...
When would you consider adjuvant chemoradiation in a patient with esthesioneuroblastoma?
In both situations, I would give cisplatin concurrently with post-operative RT. One could make an argument for the combination regimen as this is a rare tumor lacking in randomized controlled phase III trials to establish standard of care. Multimodality management is extrapolated from HNSCC and neur...
What is the appropriate radiation volume for a stage III, group III unresectable embryonal rhabdomyosarcoma originating from the bladder?
For bladder/prostate or pelvic tumors that displaced a significant amount of bowel which has then returned to its normal anatomic position after chemotherapy, GTV1 and CTV1 will be defined by the prechemotherapy extent of tumor excluding the component that is now normal intra-abdominal components (i...
What is the utility and optimal timing of histologic conformation of NGGCT?
This is a difficult topic and a great question. Unfortunately, the thresholds for tumor marker cut-off values vary internationally for germinoma and NGGCT. The Japanese, who do more aggressive surgeries and have a wealth of experience, use higher cutoff values for germinoma, however, they typically ...
What is the anterior expansion for the paraaortic CTV in endometrial and cerivcal cancer?
Usually, around 5mm with editing based on the patient's anatomy and fixed organs like the duodenum. Kabolizadeh, Fulay and Beriwal - PMID 23849691
How would you counsel a patient with extragenital lichens sclerosis on the acute and long term risks of post-lumpectomy radiotherapy?
Lichen sclerosis (LS) is a rare entity, however, there are reports of successful treatment with radiation for various cancers associated with this condition. (Wang et al., PMID 33356763). There is also a suggestion of worse LC in women with vulvar cancer and preexisting LS (Fokdal et al., PMID 34392...