Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you prevent non-healing ulcer when treating patients with cutaneous SCC of the distal lower extremity who have peripheral vascular disease?
@Dr. First Last points are well taken but he does not mention dose fractionation. For most skin cancers, I usually treated with a fairly short course of RT , e.g. 400×10, but not in this situation, where a longer course, e.g. 60-70 Gy in 2 Gy fxs may be desirable.
Is it acceptable to omit post-lumpectomy radiation in an elderly patient with recurrent, ipsilateral breast cancer but low risk features?
In terms of omitting post-lumpectomy radiation, its about assessing risk. If this is a recurrence in the same area or proximity ("true recurrence"), I would consider RT in light of recurrence particularly if time from original diagnosis was short. If this was a recurrence in another quadrant or dist...
What is your recommended surveillance imaging routine for a patient with an esthesioneuroblastoma following adjuvant radiation?
My surveillance strategy is: First followup PET and MRI at around 4 months. Follow up with HN surgery and rad onc every 4 months. Repeat imaging at 6 months. Repeat imaging yearly or if needed.
How would you manage a localized stage IV squamous cell carcinoma of vagina involving the posterior vaginal wall and full thickness of the anterior rectal wall?
I would get staging scans including PET and MRI and plan for definitive chemo RT with a final boost, most likely with IMRT, to 66 to 70 Gy.
Would you offer regional nodal irradiation for cN1 breast cancer patients who undergo neoadjuvant chemotherapy and experience a complete nodal response?
This issue frequently comes up in patients where there appears to be equipoise in treating or not treating the regional nodes in breast conserving therapy (or offering post-mastectomy chest wall and regional nodes in mastectomy patients) with a complete pathologic response or conversion to node nega...
Would you deliver SBRT to the adrenal gland if a patient has already undergone contralateral adrenalectomy for oligometastatic NSCLC?
I have treated one patient in a similar scenario, with bilateral adrenal metastases. I referred the patient to endocrinology for counseling about the need for future adrenal hormone replacement, and after thoroughly discussing these implications with the patient, we proceeded. This is of course an e...
What is the role of adjuvant radiation therapy for isolated melanoma lymph node metastases, status post resection and found to have extranodal extension?
Adjuvant lymph node basin radiation therapy reduces the risk of regional lymph node basin recurrence in this situation. Lancet Oncol., 2012 vol. 13(6) pp. 589-97
How do you approach treatment planning for preoperative radiation therapy in gastric cancer?
At MD Anderson, we treat nearly all gastric patients using a neoadjuvant strategy. I've outlined our approach below: For simulation- NPO 3 hours, 4DCT For target delineation- iGTV (from PET, endoscopy report, etc). Mucosal margin expansion = 3cm along the mucosal axis (sup, inf and into the uninvolv...
How would you treat oligoprogressive metastatic GIST to the liver with a single enlarging liver lesion while on imatinib and no other evidence of active disease, where surgery and RFA are not possible?
Please refer to my answer for "Adjuvant RT in GIST" in the Sarcoma section for complete details, but as relative to this question: In the palliative setting, I have radiated a handful of GIST patients who either had painful bone mets or a tumor of the liver with limited other options. If you review ...
What dose-fractionation would you utilize when treating an elderly patient with local-only pancreatic cancer who is not eligible for systemic therapy or surgery?
Elderly means different things to different people. Both PS and age have to be considered. Fatigue in particular is an issue with radiation in the elderly with poor PS. They bounce back very slowly. We now offer a definitive option using an SBRT technique, DIBH, CBCT IGRT, and selective adaptive pl...