Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage breast lymphedema after radiation?
We refer to lymphedema physical therapist for management.
Do you use a custom wax tongue immobilizer for oral cavity radiotherapy?
We have not used a device which aimed primarily to immobilize the tongue. Rather, we use a customized device (“radiation guards”) which primarily aims to reduce backscatter from metal fillings or crowns in the teeth into the surrounding gums and adjacent tongue. This device has been described by Ben...
Do you typically recommend re-resection for secretory carcinoma of the parotid with focal positive margins?
In my experience, it is always difficult finding the focal margins in question on re-resection in the post-op parotid bed, if not downright impossible. Most of the re-resection margins come back negative in case of focally positive margins. Unless re-resection surgery entails wide local excision tha...
How would you approach an isolated supraclavicular nodal recurrence of breast cancer in a patient who was treated with breast conserving surgery and whole breast radiation without RNI?
I think there are several approaches: 1. Surgically resectable: not always offered, but can consider staging, consideration of neoadjuvant chemotherapy and surgery, followed by adjuvant RT. If more than 2 years from original RT, I consider comprehensive treatment (standard or hyper fractionation) vs...
Would you omit postoperative radiation to the neck for a patient with advanced T-stage HNSCC and high risk features and bilateral pN0 neck dissection?
In general, if the neck has been operated on and the appropriate levels have been dissected, for all practical purposes it has been treated, and as such does not need to be irradiated. However, in practice, and based on historical practice patterns and consensus guidelines, the entire operative bed ...
For post-prostatectomy radiation, are there any special considerations if there is a bladder sling or artificial urinary sphincter?
Great question. I have treated patients with artificial sphincters and penile prosthesis, and the thing I noted was one of the most important thing to do: document the urinary status of his function. I can say that for the most part I typically saw my patients after they have developed PSA progressi...
Do you insist on biopsy confirmation of invasive disease in the setting of in situ pathology findings but otherwise clinical/radiographic evidence of invasive cancer?
Not necessarily. I recently had a case of cervical cancer which was called CIN 3 on 2 consecutive biopsies with a palpable mass approximately 3cm in size on clinical exam. PET/CT showed intense FDG avidity in the cervix with a 5cm mass and pelvic lymph nodes. We treated as a IIIC invasive SCC. While...
What would you recommend for a stage I follicular lymphoma of the bone?
Definitive treatment would be 24 Gy/12 to area of disease with margin (not entire bone). See ILROG guidelines for extranodal lymphoma (Yahalom et al., PMID 25863750).
How would you manage a patient with intact prostate cancer with metastases to a para-aortic node and single bone?
I would consider treating the primary site per STAMPEDE as well as possible SABR the other lesions, so long as he understands this is an evolving area and the benefit has not been conclusively demonstrated. Would recommend confirming the bone lesion by biopsy as well.
What bowel dose constraint do you recommend if you are boosting a pelvic lymph node for prostate cancer?
We generally use 55 Gy to < 5 cc based on Gyne literaturem and try to make sure the high prescribed dose is limited to one wall of bowel loop.