Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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.
Is peritoneal dialysis a contraindication to pelvic radiotherapy?
I have never done it except for a few patients with palliation as treating the entire pelvis may increase the risk of complications of dialysis and also may decrease efficacy and with changes in peritoneal permeability unless treating localized field like prostate or below the peritoneal reflection....
Is there any reason to stop mesalamine in a patient with UC undergoing breast/regional nodal radiation?
I have run into this situation a few times and have not stopped mesalamine during breast radiation. Have not noticed any issues.
For a young patient who had a prior pCR to neoadjuvant therapy, would you consider systemic therapy after local resection and radiation of an isolated brain metastatic recurrence of triple negative breast cancer?
We have had prior discussions about this clinical scenario and there was a range of opinions due to the lack of definitive data in this space. Many felt that if a patient was NED after the resection that they could be observed as some patients can remain so with no further systemic therapy. I think ...
How do you decide whether to offer PCI in patients with ES-SCLC who cannot get brain MRIs?
The Slotman study that showed a benefit for PCI did not have CNS staging (CT or MRI) done routinely for asymptomatic patients, so I don’t think of it as PCI. Since 30% or so patients with SCLC have brain metastases, this version of “PCI” is just treating brain mets. That’s probably what produced the...
Is a close (<1mm) posterior margin an indication for lumpectomy cavity boost in a patient with early stage breast cancer when dissection was carried down to the pectoral fascia?
In the setting of invasive breast cancer, a meta-analysis and guidelines have determined a negative margin is no tumor on ink. So as long as margin is > 0, I would not consider a close margin (often considered for 0-2 mm) to be a sole reason to boost. In the setting of pure DCIS, current guidelines ...
How does the presence of ascites affect your treatment planning for SBRT for HCC?
This is not an unusual situation in clinical practice, as it is common for HCC patients to have both benign and malignant liver disease. It is important to weigh the risks of aggressive SBRT in the setting of malignant ascites. In my practice, I find it is rarely the appropriate option. However, if ...
Would you treat the contralateral neck in post-op parotid salivary gland malignancy with multiple positive nodes ipsilaterally?
Not unless there are suspicious contralateral nodes. Parotid drainage is ipsilateral and it makes no clinical sense to me to treat CL neck electively.Of note, the paper cited is on submandibular gland cancers, not parotid. With SMG, there is a chance of CL mets if the initial presentation has very a...