Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat the mandible if the patients has osteonecrosis from zoledronic acid but also multiple myeloma in this region, biopsy proven?
Plasma cells can be seen in mandible biopsy without myeloma in that region. Have had a similar patient. However, if the patient has confirmed myeloma relapse elsewhere or systemically then would treat relapse with chemo. Denosumab or zometa is contraindicated due to confirmed osteonecrosis. Not sure...
Would you consider re-irradiation in the setting of prior salvage prostatectomy after prostate brachytherapy?
I would not offer further local therapy in this situation, especially given that there is no direct evidence of disease within a usual post-operative treatment field. I would be very concerned regarding the potential of serious morbidity resulting from further radiotherapy, especially considering th...
Would you offer whole lung radiation therapy in a head neck patient who relapsed with multiple lung only mets?
I would definitely not do WLI in this scenario, refer to Med Onc for systemic therapy. Makes perfect sense to consider SBRT or limited resection if there's only limited biopsy proven disease or a persistent lesion despite systemic therapy, as stated in the much more eloquent and detailed answer abov...
What would be your approach to the treatment of limited stage extrapulmonary small cell carcinoma of the nasopharynx with bilateral cervical lymphadenopathy?
Rare entity and not a whole lot of evidence to base treatment decisions on. That being said, at least make sure a brain MRI has been completed (I know this seems obvious, but just in case).If the patient was in good shape, I would treat with concurrent CRT based on a series out of Japan. Whether to ...
What fields would you treat for a postmastectomy patient with a single suspected small IMN node on MRI but no other criteria for PMRT and a negative SNB?
If treating based on suspected IMN, I favor treating the chest wall with comprehensive RNI.
How would you treat grade 3 cauda equina meningioma status post biopsy only with a history of prior prostate/whole pelvis radiation?
This question is anything but routine. WHO grade 3 spinal meningiomas are exceedingly rare. I’ve been treating meningioma patients my entire career, now beyond 3 decades, and have never seen one. If this patient’s prostate cancer radiation therapy (RT) were many years ago and if his meningioma were ...
Do you offer APBI to patients who do not have surgical clips but a visible seroma?
Yes, if open cavity surgery, we don’t place clips and define CTV based on seroma. If type 1 oncoplastic then need clips to help define CTV.
How would you optimally manage a small solitary plasmacytoma of the alveolar ridge, including minimizing the risk of dental toxicity?
The alveolar ridge is an osseous structure (extension of the mandible and maxilla) that houses the sockets of the teeth. Assuming an appropriate work-up demonstrates no evidence of multiple myeloma (bone marrow biopsy, PET-CT/MRI, laboratory work, etc.), a plasmacytoma arising in this region would b...
Is it safe to give spine SBRT after recent cryoablation?
There is a small randomized trial (CROME) of SBRT vs Cryo + SBRT open at MD Anderson addressing this question. In this trial, SBRT is done within a few weeks of cryotx. The trial is still accruing and results are not available. In lieu of randomized data, I think it would be reasonable to consider S...
For a small (<5 mm) hard/soft palate junctional primary with DOI <2 mm status post limited excision with negative but close deep margin, how would you approach neck management in the adjuvant RT setting?
Postop RT to primary plus elective neck RT.