Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer neoadjuvant radiation therapy for oral cavity sarcoma?
Rare situation. Be sure the path is unequivocal (and not e.g., a sarcomatoid SCC, which is not at all a sarcoma). If it really is a sarcoma, preop (50 Gy/25 fx with sarcoma expansions) is reasonable if your surgeon is comfortable with it, but oftentimes there is less familiarity/comfort with preop R...
Would you offer radiation for Stage III NSCLC in a non-surgical candidate with prior post-mastectomy chest wall RT?
Yes, I would offer definitive thoracic radiation (60 Gy standard fractionated) to a patient with prior h/o postmastectomy chest wall radiation, even if the lung cancer is on the same side as the irradiated chest wall. Likely the dose to the chest wall was around 50 Gy. If there were any areas of che...
How will you manage a patient with symptomatic secondary CNS involvement from DLBCL not eligible for HD-MTX?
Patients with secondary CNS lymphoma have historically had a very poor prognosis. Depending upon circumstances, many patients today are treated with a chemotherapy regimen that penetrates the blood-brain barrier (e.g., MATRix). If the patient responds favorably and is fit, high-dose chemotherapy fol...
Does an EGFR mutation in a never-smoker change your radiation treatment recommendations for ES-SCLC?
First, worth a close pathology review at a specialty center. EGFR mutations in de novo small cell are exquisitely rare. The more common scenario is small cell transformation from adenocarcinoma. If this has features of adenocarcinoma, I’d favor a metastatic non small cell paradigm with EGFR inhibiti...
What can be done to help rehabilitate trismus secondary to radiation and surgery?
Physical therapy. Stretching exercises. If present prior to treatment, it is unlikely to improve. It will likely be a chronic problem.
For insurance, how do you justify medical necessity for IMRT to the pancreas in the preoperative, unresectable, and post-operative settings?
I work in prior auth. In all three cases, IMRT would be auto-approved where I work. Other third parties are restrictive about this and it is unclear to me why. In any case, though it is burdensome, if I was in a region that was restrictive, I would do a comparison plan right off the bat. As annoying...
Would you offer empiric radiation for a growing mediastinal mass radiographically suspicious for thymoma in a patient who declines surgery?
If the patient truly refuses surgery, they need to undergo a core biopsy to get a tissue diagnosis due to the variety of potential histologies (ranging from thymoma, thymic carcinoma, lymphoma, germ cell tumor, primary lung tumor, etc.) each requiring distinct management strategies. Even...
Do you routinely obtain a spine MRI for all patients planned for palliative spine RT?
If the treatment plan involves conventional EBRT for palliation of painful spine metastasis, reasonably identified on other imaging and correlating with the patient's location and nature of pain, I believe an MRI may not be necessary. However, if there are symptoms indicative of epidural spread or n...
How do you approach breast RT in a patient with a recent history of ipsilateral thoracic irradiation?
When patients have two simultaneous cancers, it is necessary to carefully plan the treatment strategy from the beginning in order to maximize the chance of cure of both cancers with the minimum possible toxicity. It is not clear what kind of surgery this patient had for her breast cancer, nor why th...
What are your thoughts on the relevance of sentinel lymph node biopsy before the onset of neoadjuvant chemotherapy for HER2+ or triple negative cT2+N0M0 breast cancer patients?
We don’t favor SNLN bx upfront as systemic agent is the same for the two phenotypes for T2 and the above disease and will tailor the RT field based on the final pathology.