Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient s/p lumpectomy+RT for an early stage breast cancer, who later has recurrent disease requiring mastectomy and PMRT, under what circumstances would you recommend a boost?
If already had WBI and now requiring PMRT, I only boost for positive margins, inflammatory recurrence, or if skin involvement.
What would be your approach for a patient with triple negative metastatic breast cancer with oligo-progressive disease in the axilla alone?
Would evaluate with breast surgeon. Can consider surgery if other disease stable for > 6-12 mo, followed by +/- RT. Important to consider if primary was already treated and if this is on ipsilateral/contralateral side.
How would you proceed when a cervical cancer undergoing brachytherapy has exceeded the rectal dose but not met the target dose?
Rectal dose and target dose have range. Preferred rectal dose for D2cc < 65 Gy but can accept up to D2cc < 75 Gy, provided you understand expected risk of complications with increased dose. Preference would be to do hybrid applicator with 3D imaging to optimize HRCTV and OAR.
How would you approach a resected solitary osseous plasmacytoma?
With a few exceptions, surgery is rarely pursued as a definitive modality in hematologic malignancies. I have never seen an orthopedic oncologist attempt an oncologic resection for a solitary plasmacytoma of bone, so my subsequent thoughts are theoretical. In the (very unusual) situation posed, if t...
How would you manage a dehiscent vaginal cuff 2 months after vaginal cuff brachytherapy?
It has to be a combination of surgery and radiation. Partial small dehiscence can sometimes be managed conservatively otherwise, most need surgical fixation.
In a patient with favorable risk pT1N0(mic/i+) breast cancer and favorable anatomy, would you use IMPORT-LOW style PBI while incorporating the high axilla?
For N0(i+), PBI is appropriate, I would not include axilla. 40/15, 30/5. If N1mic, would not use PBI but would favor WBI, high tangents if ER+, RNI if ER-.
Would you use IMRT to treat stage II seminoma?
I wouldn't use IMRT, but I have used protons in 20-40 year old patients, who, like peds, have a long lifetime at risk of secondary malignancy. The NCCN guidelines for Seminoma, Principles of Radiation Therapy, specifically advise against using IMRT and recommend 3D conformal. This is due to fear of ...
How would you treat a recurrent ovarian malignant mixed Mullerian tumor on the pelvic side wall?
I would treat with IMRT and IGRT with total dose equivalent to 66 Gy based on OAR dosimetry to buy time without chemo and improve PFS.
What is the best approach to treat a triple-negative inflammatory breast cancer with pCR following preoperative chemotherapy and a prior history of ipsilateral breast irradiation?
Given inflammatory breast cancer recurrence, even with history of previous breast RT, I would offer reirradiation. Given DCIS, nodal irradiation would not have been used and the breast would be removed at mastectomy leaving chest wall. I would give dose of 50 Gy to CW and nodes, and I would use some...
What risk/pathologic factors merit PMRT for a patient with recurrent breast cancer and a prior history of ipsilateral breast irradiation?
My threshold for reradiation PMRT is higher. Would do for upfront 4 or more positive node or persistence of nodal disease after chemotherapy. If there is complete response to chemotherapy, then would avoid PMRT unless inflammatory breast cancer.