Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you include ipsilateral nodes in adjuvant RT for bulky Mammary Analogue Secretory Carcinoma of salivary gland?
I assume that the bulky lesion was dissected, likely by superficial parotidectomy (if it arose in the parotid gland), and that postop RT is indicated in this low-grade tumor due to positive/close margins or facial n involvement. While the risk of LN metas is small, the inclusion in the targets of ip...
For a chest wall scar boost with a very long scar that requires 2 electron fields, how do you do that clinical setup?
If need be, I have used abutting/matching electron fields (match on skin).
What is your approach following R1 resection in a patient who has received total neoadjuvant therapy for rectal cancer?
This is a challenging scenario and there is not a one-size fits all solution. My decision making would involve thorough assessment of the patient's performance status, co-morbidities, pre-treatment extent of disease, tolerance of therapy, and review of what TNT regimen was employed: number of chemo ...
How do you approach fertility preservation in a young child with cancer?
After the diagnosis is known, we meet with the families to discuss the known risks for infertility based on what we know about the treatment regimen they are to receive. For example, a patient with Ewing's sarcoma will receive high dose alkylators and therefore, is at significant risk for future inf...
Do you give Cetuximab concurrently with SBRT for recurrent head and neck cancers previous treated with definitive radiation?
This is an area of active clinical trial development esp. as it relates to immunotherapy concurrent with SBRT. That being said, we certainly have phase I, II, and preliminary phase III data suggesting that SBRT in the setting of recurrent disease is safe and may offer extended LR control rates in a ...
In what situations would you consider memantine when treating multiple brain metastases with SRS?
The study by Brown et al., PMID 23956241 showing the benefit to memantine in terms of delay/decrease in neurocognitive function was in patients receiving whole brain radiation therapy. That is why I routinely offer memantine to patients receiving WBRT. (Even with the study results, I almost always h...
Do you offer partial breast irradiation to woman with a germline variant of unknown significance (VUS) who otherwise fall into the "suitable" ASTRO category?
I would feel comfortable offering an otherwise suitable patient PBI with a VUS.
What dose regimen would you use to treat a patient with locally advanced esophageal SCC of the mid-esophagus who refuses chemo and surgery, agreeing only to radiation alone?
The 5Y survival of RTOG 8501’s RT alone arm was 0%. They used 64/32 Gy. So... I tend to think that RT alone is purely palliative and generally stick with 40/15 to provide palliation and hopefully some local control. 50/25 not unreasonable, but please don’t use the RT alone arm of the chemoRT vs RT s...
Would you treat a vulvar SCC with definitive chemoRT with 50.4 Gy IMRT then boost the GTV with en face with electrons to ~6400?
There is no "one fits all" for vulvar cancer, which is a complex disease with varying disease presentations. The ideal method of boost and the dose depends on the size, location, histology, and other factors. We used to use en face electron boosts much more frequently before we began using IMRT. It ...
What risk, if any, do you quote for erectile dysfunction in a young male being treated for a lumbosacral ependymoma?
I have not been quoting a specific risk of ED in spinal ependymoma patients. ED is common with advancing age and is often multifactorial. In ependymoma, prior spine surgery, the disease itself, concurrent medication, concurrent health issues, and the psychological impact of a cancer diagnosis are, f...