Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you consider adding a brachytherapy boost to IMRT in patients with cT3b and/or cN1 prostate cancer?
For T3b disease we do consider a brachy boost. We look at MRI imaging and based on extent of involvement which usually is to proximal part, and if it appears we can implant that area to full dose, we consider a brachy boost.
How would you treat a pediatric embryonal rhabdomyosarcoma of the kidney with preoperative rupture s/p nephrectomy and getting VAC/VI chemotherapy?
This is an uncommon clinical presentation. If there was diffuse abdominal spill, then whole abdominal radiotherapy would be indicated. Though recent COG study guidelines specify 24 Gy whole abdomen radiotherapy dose, that may not be adequate for microscopic tumor. In other tumors (ie, diffuse small ...
Do you recommend elective lymph node irradiation for a basal cell carcinoma of the skin that is deeply invading muscle?
The decision to treat lymphatics would depend upon the level of differentiation of the basal cell carcinoma. It is not unusual for a large [4 cm] lesion to deeply invade and destroy surrounding normal tissue. This does not necessarily mean that it will have spread into the lymphatics. Over the past ...
How would you advise your patient about starting adjuvant breast radiation who has a planned vacation?
I would be reluctant to delay initiation of RT for that long in patients who had neoadjuvant chemo and lumpectomy. No prospective study but retrospective data shows inferior outcome when RT is delayed beyond 8 weeks or so for patients who have NACT.
What techniques do you use to minimize gas artifacts on cone beam CT when treating upper abdominal lesions?
Gas and motion artifacts are significant causes of poor image quality for imaging studies that have a long acquisition time such as cone beam CT. The problem areas are in the upper abdomen where the impact of respiratory motion is greatest. Organ motion can be controlled in most patients, but the pr...
How do you treat recurrent tracheal carcinoma?
Endotracheal HDR can work, though will be hottest on the luminal surface and have limited penetration. Another strategy to consider was just published: "Percutaneous CT-fluoroscopic-guided radioisotope seed placement for the management of adenoid cystic carcinoma of the trachea."
Should NSCLC with positive cervical nodes be managed with definitive chemoradiation?
The AJCC staging system in conjunction with the IASLC lymph node map is quite clear on this issue. Cervical lymph nodes are non-regional and in the TNM classification are noted as M1b or stage IV. From a practical standpoint though, one should consider the number and location of the lymph nodes in q...
Would you consider post-mastectomy radiation in patient with a triple negative tumor pT2N0?
In borderline cases, I look at some of the retrospective data showing higher recurrence rates in patients with close margins, premenopausal status, higher grade and T2 tumors.In the specific case in the OP, I would discuss the data from the Chinese randomized trial (green journal 2011) showing an OS...
What IGRT strategy do you use when treating intact prostate and lymph nodes?
This does become challenging at times. Most of the time we give a slightly larger PTV margin for nodal CTV and keep similar margins for the Prostate. We align daily to Prostate as it is being treated to higher dose and make sure PTV margin which is given to nodes is sufficient to cover nodal CTV. On...
What are your considerations in choosing partial breast irradiation versus external beam hypofractionated whole breast RT for early stage breast cancer?
Accelerated partial breast irradiation has become a standard of care option for appropriately selected patients. Currently, patients who can be offered APBI come from the ASTRO guidelines or the more recently updated ABS partial breast guidelines released.In general, I will consider APBI for node ne...