Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your radiotherapy recommendations for a unilateral primary intraocular large B-cell lymphoma following high-dose methotrexate and rituximab?
Primary intraocular lymphoma is quite rare without standard treatment guidelines. As PCNSL often involves the globe, at initial diagnosis and/or at relapse, I view isolated intraocular disease as a subset of primary CNS lymphoma. HD-MTX regimens are typically utilized. As the disease is localized, c...
How do you manage patients with locoregional lymph node recurrence after radical cystectomy for muscle invasive bladder cancer?
Recurrent bladder cancer is typically a systemic disease. I would start with cisplatin based chemotherapy first and then add consolidative radiotherapy. There is a small body of literature on surgical consolidation as well. In our single instiution experience patients did very well following radioth...
What dose-fractionation and technique do you use when treating lentigo maligna?
57.5 Gy/23 fractions using superficial (100 kv) radiotherapy in most situations, as long as the target is not too large. There are a variety of dose fraction schemes used which are generally dependent on technique (Grenz, orthovoltage, skin surface brachytherapy, megavoltage electrons), but this is ...
Would you offer preoperative radiotherapy for muscle-invasive SCC of the bladder (catheter associated)?
The use of pre-operative radiotherapy for locally advanced bladder cancer has not been routinely utilized or part of the standard of care. That being said there is a long history of tri-modality bladder preservation therapy in which pre-operative chemoRT has been utilized and radical cystectomy util...
How would you approach definitive prostate radiation in a patient with evidence of seminal vesicle invasion on MRI, but with adjacent small bowel?
This is a situation where I find an HDR boost can be very advantageous. In most patients I have found that the catheters can easily be placed into at least the first 3 cm of the seminal vesicles, often further. The advantage of HDR over LDR is two fold in this scenario. First, one can manipulate the...
How do you approach the treatment of patients with unresectable paransasal sinus cancers in close proximity to the critical structures of the base of skull?
These (SCC of the BOS/sinonasal) are rare, complex and generally have poor outcomes (low 2 digit survival %). Optic nerve/chiasm, pituitary and cochlear organs are at risk and must be carefully considered. Careful review of imaging with the radiologists (MRI and CT) is recommended. Avoid more than 1...
How long after definitive treatment is it reasonable to consider reconstruction for a woman with inflammatory breast cancer?
I don’t think it is an absolute contraindictation to immediate reconstruction. It is driven by patients desire, her expectations of cosmetric outcomes with RT and type of reconstruction feasible for her
How would you treat esthesioneuroblastoma resected with focal microscopically positive margins in difficult to resect skull base regions?
Yes, it is often difficult to get negative microscopic margins in the anterior skull base in spite of combined ENT and neurosurgery approach. I would be comfortable at this stage to go ahead with adjuvant treatment. The dose of radiation in these situations with microscopic margins would be 70 Gy in...
Do you have any recommended techniques or tips for palliative radiation to a digit (e.g. thumb)?
In my experience, I find Electrons very useful for palliating pain inafflicted digits of the fingers. Because I have lost a few fingernails in my day as well, losing one is NOT a major component of my planning emphasis because they, fingernails,do come back if the patient lives long enough. Most pat...
How would you manage a patient with synchronous locally advanced H&N (p16+) and locally advanced rectal adenocarcinoma?
This is mostly a question of addition of chemotherapy (5FU with Cisplatin) and the timing of radiation therapy to the primaries. The dose of 5U if added for the H&N is not going to be of much effect for the rectal cancer since that would require a weekly 5-day PVI of 5FU. I actually contacted our me...