Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For a breast cancer patient who previously underwent lumpectomy/SLN biopsy and PBI with brachytherapy, what volume would you treat for an isolated axillary recurrence s/p ALND and chemo?
How long has it been since initial brachytherapy? If > 2 years from initial treatment, I typically will treat breast/chest wall and regional nodes. If < 2 years, I would consider regional nodes only; however, would also look at the original plan as some UOQ PBI cases may give a dose to the axilla.
What is the role of SRS in the treatment of malignant gliomas?
This is a good question that has been formally studied. RTOG 93-05 was a negative phase III randomized trial of chemo-RT with or without an up-front SRS boost for glioblastoma. Results were published in the Souhami et al., PMID 15465203. Tumors had to be 4 cm or smaller to be eligible. Tumors were a...
How do you handle risk stratifying and radiation treatment in a patient with concurrent MRI diagnosed asymptomatic prostatitis and prostate cancer diagnosis?
My concern, in this case, is that whatever has been uncovered by the MRI might be artificially elevating the PSA, which might result in erroneously classifying the patient into a higher risk category, leading to more treatment than is necessary. Personally, I have never seen a clinically significant...
Does diffuse high grade PIN in a low risk prostate cancer patient affect your recommendation for surveillance?
No. If the patient otherwise has low-risk prostate cancer, surveillance is appropriate. The diffuse high-grade PIN might raise the chance of occult cancer (that could be higher grade), but not more so than a widespread Gleason 3+3 disease, which is not, by itself, a contraindication to active survei...
What is your treatment approach to radiation-induced meningiomas?
There is an unambiguous relationship between ionizing radiation and meningioma, the most commonly reported radiation-associated neoplasm [1,2]. It is thus perhaps curious that radiation therapy (RT) is 1 of the only 2 definitive management options for meningioma in the current era. Systemic therapie...
What techniques do you typically use for a photon breast boost?
Depends on the location of the cavity and depth, and breast anatomy. Mini tangents work well but can have a lot of doses beyond boost volumes. I sometimes will use a 3 field approach with a lightly waited anterior electron/photon field depending on the depth of the cavity.
Is there a role for post operative elective nodal irradiation in locally advanced sinonasal, clinically N0, intestinal type adenocarcinoma (ITAC)?
While I agree with Dr. @Dr. First Last's reply regarding post-operative ENI for high-risk sinonasal malignancies, I would like to offer a few points about treatment technique: Historically, treatment with conformal RT for localized malignancy at paranasal sinus (PNS) or nasal fossa would involve ort...
How would you manage newly diagnosed spinal cord compression presenting with paraplegia without tissue confirmation?
How do you approach the pharmacologic management of cancer-related fatigue?
After the above considerations mentioned in the question, management considerations regarding cancer-related fatigue depend on the stage of disease (advanced/metastatic disease vs not) and whether the patient is on active cancer therapy. For both groups, non-pharmacologic interventions have the high...
Based on the SENTINA trial, is it reasonable to allow for axillary assessment via SLNB alone (without axillary dissection) after neoadjuvant chemotherapy for an upfront clinically node-positive patient?
False-negative is reduced to 5% or low with dual tracer, taking more than two sentinel nodes out and making sure bx positive node is clipped, localized, and taken out.