Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the appropriate management of breast cancer patients with axillary nodal involvement based on imaging (MRI or ultrasound) but negative axillary nodal involvement based on physical exam?
If concerning based on imaging, I would review with breast radiology expert to see if biopsy is possible, it's quite uncommon not to be biopsy. Also, regardless of the treatment approach (neoadjuvant chemo vs. upfront surgery), having a clip in the suspicious node is helpful to ensure it is removed ...
How would you manage an in-field small volume recurrence of early-stage favorable Hodgkin Lymphoma treated previously with 2 cycles of ABVD and 20Gy?
An established and extremely successful treatment paradigm for early-stage favorable HL is 2 cycles of ABVD followed by 20 Gy of RT. Assuming the patient is PET negative after chemotherapy, 5-year PFS is expected to be ~93-94% based on HD16. Most recurrences after combined modality therapy (CMT) in ...
In a patient who had a prior CABG with internal mammary grafting who now requires comprehensive RNI, what landmarks would you use to contour the IMN volume?
I am not sure I would treat IMN prophylactically in a patient with IM vessel graft for CABG.
Would you consider PMRT in a patient < 40 y.o with a with an ER/PR(+) Her 2(-) pT1, cN0 breast cancer patient, LVSI positive, who did not have sentinel lymph node biopsy?
She would need axillary nodal assessment with ALND or sampling based on pathology and would favor that for PMRT.
What dose and fractionation would you give for gastric cancer patient with solitary FDG-avid metastasis to gluteal muscle?
I believe you will get a variety of answers here, many of which will likely be biased based on the responder's training period and whether or not they subscribe to the evolving paradigm of the oligometastatic state. While gastric cancer is not heavily represented in the oligometastatic literature, i...
Would you use SBRT to a localized low grade neuroendocrine carcinoma in the head of pancreas in a patient with high surgical risk?
Yes, this is a reasonable approach that has been reported previously in the literature for pancreatic neuroendocrine neoplasms (see: Myrehaug et al., PMID 32185093; Duran et al., HPB 2021 [abstract]; a single case included in Goyal et al., PMID 21937061 as well). SBRT in this setting often provides ...
Would you recommend post-operative chemoRT for a young female patient with cT2N0 rectal adenocarcinoma who had pT2N1 disease, with 1/21 lymph nodes positive?
I would also want to know the location of the tumor in the rectum and be sure that the patient had a TME. For a mid to high rectal tumor with a TME, I would definitely not recommend RT. For a low rectal tumor, the situation is a bit more difficult. However, since there were a good number of nodes re...
Would you use de-escalated radiation or chemoradiation therapy for an incidental finding of invasive squamous cell carcinoma but with clear margins in a hemorrhoidecotomy specimen?
Yes. Would include elective nodal irradiation.
How would you treat cT3N1 ER/PR (-), Her2 (+) breast cancer who had mastectomy + ALND with a pCR in the nodes but ypT1 disease in the breast?
Given increased pCR rates, this is something we are seeing more commonly. If possible, these cN1 patients are often undergoing SLN rather than ALND if SLN is negative. I would offer PMRT for this patient given initial nodal involvement with T3 and ER- disease. Until we get data back from B51, my sta...
When staging prostate cancer, does MRI pelvis/prostate replace CT A/P?
The NCCN guidelines and recent NRG protocols allow for either CT or MRI to stage the pelvis. Assuming the MRI includes imaging of the pelvic LNs, I am not aware of an added benefit of a CT. With the increasing use of novel imaging for staging such as PSMA PET (which can be more sensitive at detectin...