Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does your institution omit prophylactic cranial irradiation in high risk ALL patients greater than 3 years of age?
The general trend worldwide has been to continue to reduce the proportion of patients receiving preemptive CNS directed radiotherapy, although some groups still utilize cranial radiotherapy in the front line setting for small subsets of patients with CNS3 disease at diagnosis, T-cell immunophenotype...
How would you treat HGIL in a woman with a history of early stage endometrial cancer?
It needs to be assessed by eua and biopsies. If only HGIL confirmed by bx, management needs to be conservative treatment like surgical excision and /or laser therapy.
How do you approach treatment of a locally advanced primary tongue SCC lesion spanning oral cavity and base of tongue?
I classify site based on bulk of disease. ChemoRT for tongue base and surgery and postop RT for oral tongue. If it’s too extensive to distinguish, which is infrequent, chemoRT, particularly if total glossectomy would be required.
How do you approach a peripheral, T1 lung cancer with a positive mediastinal node by EBUS?
I agree with @Dr. First Last's thoughtful response above. Though the idea of SBRT to a small primary is appealing, the clear standard of care here would be to deliver concurrent chemoradiation using standard fractionation (i.e. 60Gy) using standard margins and standard approach to nodal irradiation ...
What are the recommended treatment fields for desmoid tumors?
There is great clinical equipoise on how to treat desmoid tumors with radiotherapy. I apply general sarcoma princples to the CTV expansions for desmoids depending on their location. I find it helpful to obtain an MR to delineate the extent of infiltration (I am lucky in that I have access to an MR s...
Would you recommend PMRT in a patient with early stage breast cancer who has multicentric disease and close margins?
In early stage breast cancer close margins with multicentricity in itself would not be an indication for us to recommend PMRT unless has multiple other adverse factors like T2, high grade, LVSI and young age.
Do you use a metal biliary stent as a fiducial marker for cholangiocarcinoma?
Yes, I use expandable metal stents as fiducials in pancreas as well as biliary tract cancers. There is no concern for either migration or forward scatter causing complications. Please see discussion in the below letter to the editor. My only concern in the pancreatic patients is that the distal end ...
Do you change dose and fractionation when repeating RT for heterotopic ossification prophylaxis?
In the few I have done I have not changed dose Need to see if it failed because of inadequate field and and make sure at risk area is covered adequately
How are you using the data on cardiac morbidity in regards to the LV-V5 in breast cancer patients?
At present we use MHD as our hard constraints and limit to less than 2Gy for patients with breast only RT. Besides make sure that no part of beam passes through any portion of heart (thus limiting heart dose from scatter and transmission only) Darby data was also validated by similar study from UK w...
How do you manage HPV positive squamous cell carcinoma in situ of the oropharynx?
transoral surgery