Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your simulation setup when treating bladder with concurrent chemoradiation?
For the majority of our MIBC patients, we do the planning CT in the supine position with arms on the chest. In select cases with concern for small bowel dose, we will simulate in the prone position if safe and comfortable for the patient. If patients are willing and able, we typically recommend a bo...
Is there a role for radiation in a patient with supraclavicular and cervical node recurrence of breast cancer after prior whole breast RT (no ENI)?
If there is no other site of metastatic disease and the above nodes are bx proven, then I would treat this like a regional node recurrence and treat the ipsilateral axilla, s/c, and neck with IMRT/IGRT with dose to the involved nodes to about 60-66 Gy.
What is the longest treatment break you would accept when treating a patient for breast cancer?
There are no data on how a treatment break of months affects outcomes. Her prior treatment likely does not significantly reduce the risk of relapse but probably increases the risk of complications from giving her full-dose treatment. Therefore, I would not irradiate her now, since most patients trea...
Would you treat with post-mastectomy radiotherapy in patients with early-stage (T1-T2), node-negative, hormone-positive disease if the only risk factor for recurrence was a focally positive anterior margin?
Not routinely if only focal unless has a multitude of factors like LVSI, high grade and t2 disease (would also consider if high oncotype score).
How would you incorporate whole abdomen radiation therapy after cytoreduction in an AYA patient with desmoplastic small round cell tumor?
We had one patient with DSRCT. Our group used IMRT for the abdominal radiotherapy while sparing much of the kidneys. The details are in a paper by Pinnix et el, Int J Rad Onc Bio Phys 83(1): 317-26, 2012. (Epub November 2011).
What is your preferred dose and fractionation for verrucous carcinoma of the larynx?
Same as SCC which depends on stage. T1-T2a. 63 Gy/28. T2b. 65.25 Gy/29.
Would you offer partial breast radiation to a women who otherwise meets suitability criteria but is not going to receive endocrine therapy?
6 Gy x 5 APBI or 5.2 Gy x 5 whole breast based on technical suitability.
What additional pathologic or clinical features might sway you to recommend PMRT specifically for a very young patient with pT1 sentinel node negative breast cancer?
At this point, unless margin positive, I have not been offering PMRT for above subset.
How would you treat osteosarcoma that has relapsed with unresectable pulmonary metastatic disease?
Typically, I will discuss with the medical oncology team regarding systemic therapy options available as well as clinical trial options. With limited numbers of pulmonary metastases, you can consider SBRT and I have used a regimen of 60 Gy/5 fx.
Is it acceptable to treat vulvar cancers with split course radiation?
Unless the planned course is for palliation, split course is not suggested.