Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What morphologic criteria do you use to call prostate cancer N1 on imaging?
Good question. By old CT standards from the 90s that include not only prostate but NSCLC as well, the criteria for positive LNs was a short axis LN diameter of 1cm or greater. Some have used CT with MRI imaging and lowered to as low as 5-7 mm, too.Source: The diagnostic accuracy of CT and MRI in the...
Can a lumpectomy boost be omitted in a cN0 triple negative breast cancer that has a complete response after neoadjuvant chemotherapy?
At present we don't omit boost for triple negative even after pCR We do participate in the study of exceptional responder to chemo where goal is to see if surgery can be omitted ( pts get adjuvant RT to breast plus boost without surgery)
Do you treat facial and peri-parotid nodes in locally advanced nasal cavity/nasal vestibule cancer?
Yes, I cover those nodal areas for vast majority of cases. Only exception might be if lesion is posteriorly located.
When would you cover the pre- and/or post-auricular nodal basins electively in the post-op setting for tumor involving the parotid gland?
The facial nodes are rarely involved and treating them significantly increases morbidity. I typically treat levels 1b, 2, and 3 for most parotid glad tumors. I do cover them for high grade (grade 3) carcinomas and any squamous cell carcinoma metastatic to parotid nodes.
Can you spare radiation to the neck on a lateralized supraglottic cancer with cN0 neck clinically and neg nodes on PET?
I would not advise it. Supraglottis has high risk of bilateral lymph node drainage, even if clinically and radiologically node negative. Not aware of any data to support sparing the neck. You can treat to a lower dose, but must treat bilateral levels 2-4.
Do you recommend using DIBH for young adults with Hodgkin lymphoma who require mediastinal RT?
AS a general rule, sophisticated RT planning techniques are very useful for some patients but hardly necessary for all. This is particularly true for lymphoma pts where doses are often low, such as favorable HL where 2 cycles of ABVD and 20 gy is the treatment of choice ( see Dr Kelsey's answer to a...
Do you omit the breast boost in patients with lumpectomy bed near the nipple areolar complex?
In patients treated with breast conservation where a boost is indicated and the boost volume would include the nipple-areolar complex, yes I would proceed with a radiation boost. In my experience, although acute skin reactions and some additional acute discomfort may be associated with the boost in ...
How would you approach treatment in patients with stage III non small cell lung cancer invading the atrium of the heart?
Thank you for the question. I would refer to our case report from ~ 6 years ago. Link here:Atrial mass from NSCLC treated with radiotherapy in BJ Radiology. I think the short answer is that generally you have to treat it, and the best option is radiotherapy +/- chemotherapy. Modern radiotherapy is s...
Do you differ your PMRT treatment if a patient had a nipple sparing mastectomy?
I usually follow same principal and limited published data has not higher complications or nipple loss with use of RT
How do you manage cavernous sinus meningiomas?
Radiotherapy or radiosurgery depending on optic nerve dose