Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In what situations do you obtain both a pelvic MRI and EUS for rectal cancer staging and treatment planning?
I'm not sure that T2N1 is boderline - preop CRT is still a standard of care for node positive disease. Generally, thin slice (3mm or less) MRI with external (if available) or internal coil is the preferred staging modality for patients with newly diagnosed rectal cancer. Utilize the T2 images and c...
How would you counsel a patient who will undergo breast irradiation in which a large port wine stain is overlying the breast?
Port-wine stain (PWS) is the second most common congenital vascular malformation characterized as ectatic capillaries and venules in the dermis that clinically appears as a deep red to purple patch on the skin. Like other benign vascular abnormalities (symptomatic hemangiomas of spine, etc) and prio...
Would you recommend concurrent chemotherapy for a T1N1 oropharynx cancer if the patient underwent excisional biopsy of the node and was found to have ECE?
Let's look at it this way. If he had surgery with neck dissection and had pT1,N1 with ECE, one would recommend concurrent chemoRT post-op. Both the EORTC and RTOG trials included this subgroup of patients. The subset analysis of the long term follow up of RTOG 9501 showed increased local control and...
When do you offer salvage prostate bed RT to patients who have a biochemical recurrence >5 years after RP?
While retrospective data consistently suggest that biochemical outcomes (and possibly also distant metastases and prostate cancer specific mortality) are better when salvage radiation is delivered at lower PSA values, there is no absolute cut-point to trigger treatment. Many factors must be taken in...
Would you treat a T2N0 high grade neuroendocrine carcinoma of the nasal cavity after a R1 resection?
Factors such as PNI or LVI are important to consider. In my practice, I always treat these patients. Nasal cavity resections are usually endoscopic resections that result in positive or close margin so adjuvant therapy is usually needed. High grade neuroendocrine cancers have high risk of local rec...
How long after surgery for a keloid can you wait to treat with post-operative radiation before the treatment becomes ineffective?
The literature has indeed shown "the sooner, the better."Initial studies looking at this question reported that the most effective time to give adjuvant radiation was within the first 1-2 weeks after excision. However, this treatment window was soon shortened to treatment delivery to be within 72 ho...
Would you take any precautions of plan radiation therapy differently for a patient with head and neck cancer who has active Bullous Pemphigoid in the mucosal area that will be radiated?
I have no idea. Probably not. I would roll on and, hopefully, not regret it.
How do you treat an early stage breast cancer with cN0 but could not undergo a SLNB?
I almost always treat these patients with high tangents including lymph node levels 1 and 2 in the tangential beam. There are multiple studies showing excellent regional control with this approach.
What is your approach to management of a myxopapillary ependymoma of the conus with drop metastases to the cauda equina?
Usually I treat with localized fields but feel there is no correct answer. I offer the patients CSI as an alternative and explain benefits and risks. These patients are expected to live very long lives and 36 Gy CSI will have tremendous adversely affect on them. I acknowledge the risk of re-irradiat...
Do you have indications for adjuvant radiation in H&N cancers (oropharynx, oral cavity etc.) other than listed in the NCCN guidelines (ECE, positive margins, pT3/4, N2/3 or Lv IV/V, PNI, LVSI)?
Yes