Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend RNI for a triple negative cancer s/p lumpectomy and ALND with low LN positivity rate?
My current practice is to offer patients with triple negative disease and positive nodes after ALND RNI with their whole breast irradiation. MA20 included such patients with roughly 85% having 1-3 LN+ and more than 65% had 10+ LN removed. The addition of RNI increased survival in ER- patients (81 vs...
Would you offer adjuvant radiation for a <1 cm preauricular sebaceous carcinoma after wide local excision?
I limit the use of postoperative radiation therapy to those cases where there is a moderate likelihood of residual tumor that could develop into a clinical recurrence. In this case, I would have expected the shave biopsy to have positive margins. The lesion was then widely resected by a competent EN...
Would you give post-operative radiation therapy and/or chemotherapy after an APR for anal cancer if inguinal lymph nodes were involved but margins were negative?
This question has medicaolegal implications. We should not try to make up for the bad decisions that others have made. Since the standard of care was not followed, I would be hesitant and careful about causing any significant risk. Elective radiation to the inguinal areas would put the patient at ri...
At what dose would you recommend future audiogram screening for pediatric patients treated with radiotherapy?
I would refer to the COG Late Effects report on Auditory Late Effects (PMID: 20194279). This reference has many relevant papers in its citation list that would aid the evaluation of hearing in specific childhood cancer patient populations. They recommend audiologic evaluation including air and bone ...
How do you approach a patient with locally advanced head and neck cancer requiring chemoradiation that needs extensive dental work from an oral surgeon, but because of insurance and social issues cannot feasibly get the teeth removed?
Treat them. Teeth won’t kill them, the cancer will.
What is your preferred first line approach to patients with good PS stage IV non-squamous NSCLC that is EGFR/ROS1/ALK/BRAF WT and PDL-1 < 1%?
At least two phase III studies have now demonstrated the benefit of chemoimmunotherapy as first line therapy. The carboplatin/pemetrexed/pembroluzimab regimen, initially reported and FDA approved on the basis of a randomized phase II study has now been validated in the phase III setting (Keynote 189...
What is your recommended follow-up schedule for a meningioma after definitive radiotherapy?
For grade 1 meningioma, I obtain annual follow up MRI for the first 5 years, and then at 18-month intervals from 5-10 years. After that I offer patients to have an MRI every other year and some of them will do it.
How would you treat recurrent unresectable skin nodules on the chest wall after mastectomy and axillary lymph node dissection?
I would consider systemic treatment first based on phenotype to see if that could make it resectable.I would favor that, as surgery followed by RT would offer a better outcome.As for as RT field is concerned, I would treat chest wall and regional nodal region routinely for the recurrent disease in c...
What is your superior field (or CTV) border when treating para-aortic lymph nodes with extended field radiation therapy for endometrial cancer in the post-operative setting?
For prophylactic pa nodal region treatmentIi treat up to the renal vessels and dont use any bony landmark.If there is a node up to the renal vessels that is involved, then I consider extending 2 to 3 cm above the involved node including and contouring retrcrural region.See below reference for above ...
How would you treat the axilla if a breast cancer patient had cN1 disease in the axilla but after neoadjuvant chemo the SLNB revealed no positive nodes and the clip placed in the axilla was not found?
I would image to make sure clip and node not in situ if not there based higher false negative when less than3 nodes are retrieved and clip not found would treat regional node comprehensively