Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For patients with small, early stage breast cancers that undergo cryoablation, do you ever offer adjuvant radiation?
I would first counsel patients that outside of prospective studies, cryoablation is not a standard approach in the management of breast cancer and would refer to the breast surgeon for consideration of appropriate breast surgery.If on study or patient is unwilling to consider surgery, you can consid...
How would you manage a cT2, N0 poorly differentiated mucoepidermoid carcinoma with sarcomatous features/carcinosarcoma affecting the soft palate?
This is such an uncommon entity that one can only make a best guess, and in theMednet forum where only a brief synopsis is provided, it is even more challenging. In general, Mucoepidermoid cancers are treated with surgery, and the pathologic entity (of sarcomatous features) would not change this. T...
What chemotherapy do you use with radiation for urothelial carcinoma with squamous differentiation?
In case of primary or dominant urothelial carcinoma with squamous cell features, would approach similar to pure urothelial carcinoma and consider same radio-sensitizing chemo that we are using in S1806 phase III trial. Doses below may not fully reflect S1806 protocol and also depends on the patient ...
What would you offer postoperatively for a pt with resected 3 separate HPV+ SCC primaries with pN1 disease with ECE who is cisplatin ineligible?
In view of this patient having ECS and three primaries (including bilateral disease), I would definitely treat postoperatively with chemotherapy in conjunction with radiation therapy. I still favor a platinum-based regimen in view of this patient's neurological toxicity due to previous cisplatin exp...
Would you ever consider SBRT for de novo cutaneous squamous cell carcinoma?
No role for SBRT.
What is your approach to postoperative radiation therapy in a patient with INTERMEDIATE grade early stage (I/II) mucoepidermoid carcinoma of the parotid and no other risk features?
Treat like a low grade. There are clear data on this point. Negative margins, follow even if close.
What consolidative radiation volumes and dose would you use for plasmablastic lymphoma of the L maxilla s/p incisional biopsy and 6 cycles of EPOCH-R?
Plasmablastic lymphomas are particularly aggressive NHLs with features of both plasma cell neoplasms (e.g., CD138 positive) and B-cell lymphomas, but they are usually CD20 negative. They frequently arise in the oral cavity. Underlying immunodeficiency such as HIV infection is common. There is arguab...
Would you treat regional lymph nodes in an elderly patient with a triple negative pT2 IDC of the UOQ of the left breast s/p lumpectomy with N0 sentinel node biopsy, but was clinically node negative?
What was the reason SLNB was omitted? While pathological nodal assessment is sometimes omitted, that most commonly applies to patients who are older (age >70) with small (T1) tumors that are ER positive, paralleling the inclusion criteria of CALGB 9343 in which 2/3 of patients did not have pathologi...
What radiation approach do you prefer when using total neoadjuvant therapy for rectal cancer with extensive anal sphincter or pelvic floor involvement?
Yes, the inguinal nodes should be treated and no, it should not be with short course. When the anal canal has to be treated, it is best to use long course chemo radiation because the following surgery the long-term bowel function is better according to patient reported outcomes from the UK national ...
What is your preferred IGRT approach when treating with ultra-hypofractionation for breast cancer?
If ultra-hypofractionated PBI, we do daily CBCT. If ultra-hypofractionated WBI, we do ports once during course. Exception is if we use an SIB boost. Also, regardless of laterality, we use DIBH for ultra-hypofractionated PBI and WBI.