Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What radiation strategy do you use in clinically node positive pancreas cancer responding to neoadjuvant chemotherapy?
For locally advanced disease or any situation where the surgery is not a definite option, we recommend ablative radiation (100Gy BED equivalent). That includes an ablative dose to the GTV imbedded within a microscopic dose PTV that includes wide coverage for microscopic extension to nodes along vess...
How do you approach sequencing of systemic therapy and radiation in NSCLC with epidural invasion?
Assuming that there are no targetable mutations in this case, I would give chemo and RT concurrently if possible, since optimal local control is essential in these scenarios to avoid tumor causing worsening epidural disease and symptomatic cord compression, accepting a low risk of radiation-induced ...
What adjuvant therapy would you offer for rectosigmoid junction adenocarcinoma after initial LAR?
The ideal treatment of rectosigmoid cancers is often nebulous, as depending on their presentation, they can be approached like rectal cancer or colon cancer.Given that this patient had initial surgery, I would approach this patient as a higher risk stage 2 colon cancer, based on the perforation as w...
For someone with asymmetric Graves ophthalmopathy, do you still treat both eyes, or target the single affected orbit?
Single site.
When treating whole breast, how do you minimize contralateral breast dose without sacrificing coverage and lung/heart dose?
In terms of minimizing contralateral breast dose, it starts in simulation for me. I try to make sure the contralateral breast is as far away from where medial tangent will enter. If contralateral breast is close, you can consider taping it away. For tangents only or tangents with SCV (without IMN): ...
What dose/fractionation scheme would you use for a bulky (>15 cm) metastatic renal cell carcinoma deposit with brachial plexus encasement and spinal canal invasion?
This is a remarkably complex clinical scenario where standard approaches are not likely to achieve the palliative response desired. Therefore, we would approach this challenging clinical situation with highly tailored and compact as possible SBRT-like fields using a dose fractionation of 800 cGy per...
Would you consider definitive radiation therapy (EBRT + interstitial HDR) in lieu of pelvic exenteration for a vaginal spindle cell sarcoma?
I would not favor definitive RT unless not a surgical candidate but sometimes have been able to do EBRT plus brachy after gross total excision to avoid exenteration.
What dose/fractionation would you use to treat a papillary thyroid cancer with bulky cervical adenopathy and laryngeal invasion with impending airway obstruction that is refusing laryngectomy and surgical management?
I have encountered this situation at times and assuming the patient has a tracheostomy and there is no way to convince them to undergo the recommended surgery, I have offered definitive radiation therapy. I have treated a number of patients with 70/63/56 Gy in 35 fractions ensuring coverage of level...
How do you approach management of non-resectable periampullary adenocarcinoma in an elderly patient with otherwise good PS?
The level of evidence is more limited to guide treatment decisions for ampullary/peri-ampullary adenocarcinoma compared to the neighboring pancreas. However, I have generally approached this situation similarly to locally advanced or inoperable pancreas cancer starting with systemic therapy and if t...
How you do approach adjuvant radiation recommendations (RAI and EBRT) for papillary thyroid carcinoma, tall cell variant status-post total thyroidectomy?
TCV remains the most common high risk pathological variant of well differentiated papillary thyroid cancer and often is associated with a BRAF mutation, which makes it more likely a target for systemic therapy if and when it recurs.From a postop RT perspective, it is more likely to recur both at the...