Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is adjuvant RT recommended for a Bartholin's gland SCC s/p piecemeal resection with deep invasion and negative ipsilateral LN dissection?
I agree with Dr. @Dr. First Last that it is a function of margin status. However, with deep invasion and piecemeal resection, I think that margin status would be difficult to determine. A small lesion may be able to be reresected but many times, because of the location in the bartholins gland, the t...
Is it safe to give radiation for early stage breast cancer in a kidney transplant patient who is on Tacrolimus & Cellcept?
Yes, radiation is routinely done in patients with transplant and on immunosuppressive therapy. Efficacy of RT may be reduced in this setting.
Would you offer PMRT to a young woman with high-grade neuroendocrine carcinoma of the breast?
If it is pure high grade NE carcinoma for the above pathology, I would favor observation.
How would you treat a melanoma of the penile skin in a medically inoperable patient?
As above, IO is probably preferred. That being said, I’ve had surprising responses when I thought I was treating palliatively. Although as a group thought to be radiosensitive, it is heterogeneous. I once had a CR with 30/10 in a quite ugly mass (for some reason he got biopsied and no tumor remained...
How do you decide upon a preferred dose/fractionation scheme for breast RT?
Our default fractionation for all situations with or without RNI is 40 in 15 followed by boost, if indicated. If clinically and technically suitable for PBI, then preferred is 6 Gy x 5. Use 50 in 25 if inflammatory breast cancer or poor response to chemo or residual undissected node in IM or axilla...
In what scenario would you add systemic therapy with adjuvant radiation therapy in resected, locally-advanced, cutaneous squamous cell carcinoma?
This is an active area in clinical trials, here is a recently published reviewNewman et al., PMID 34096664 More to come in a future post, I will see what trials are currently available in the Chicago area!
Would you recommend adjuvant radiotherapy for recurrent paraganglioma with lymph node involvement treated with salvage neck dissection with no residual disease?
If no prior radiation, yes with carcinoma doses. If prior RT, it would depend on whether there or multiple nodes. If not, no. If yes, I would consider more radiation.
Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?
Dexamethasone has better CNS penetration compared to prednisone and thus its established use for managing vasogenic edema. However, it has the most suppressive effect on ACTH, causes relatively more steroid myopathy and has less mineralocorticoid effect compared to prednisone hence, the general use ...
Would you consider SBRT or more conventionally fractionated radiation for an in-field mediastinal recurrence of esophageal adenocarcinoma s/p preoperative CRT, esophagectomy, and now progressing on immunotherapy?
Hard question – many variables (and answers). I think the timing of recurrence and overlap/proximity to central structures (and extent of overlap to prior RT) biggest determinants of fractionation and whether to offer RT at this junction (i.e., if ‘ultra-central’ location, would certainly consider h...
For locally advanced NSCLC with additional synchronous NSCLC primaries in the same lung or lobe, what is your approach to definitive therapy?
This is a situation that comes up surprisingly frequently and can be challenging to navigate. This assumes that one is certain which of the two lung lesions is the primary (i.e. based on discordant pathology or genomic profiling results of the nodal metastasis and/or first primary compared to the se...