Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What fractionation do you use for prostate cancer after TURP?
I would discourage the treatment of low risk prostate cancer in favor of active surveillance, especially in a situation such as this where there may be an increased risk of complications with RT. For intermediate risk, I use 1.8-2 Gy fractions and I may lower the total dose to around 75.6 Gy. For th...
Are stress-dose steroids indicated in patients with adrenal insufficiency receiving radiation therapy?
I am not aware of any direct analysis or study that has addressed this question specifically for patients undergoing radiation treatment, but I can comment on the present indications for perioperative stress-dose glucocorticoids in adrenally insufficient patients, from which certain inferences to Ra...
For patients with DCIS on biopsy but invasive disease in lumpectomy, are there any circumstances in which you would not recommend returning for a SNB?
As in all invasive breast cancer, SLNBx is standard unless it will not affect management - and this is usually for the determination of systemic therapy, i.e., chemotx. Such as a patient whose comorbidities preclude chemo for pSLN+, or patients who meet the criteria for good outcomes without knowing...
Would you recommend post-op RT for an ulcerated Clark's level IV melanoma of the zygomatic/preauricular region following a WLE with diffuse melanoma in-situ at the margins?
Yes.
Would you treat regional nodes in a patient with complete pathologic response on axillary dissection after neoadjuvant chemo for isolated axillary recurrence?
I would treat, in these cases. In terms of volumes, it depends on the time from the first course of RT. If >5 years from RT, I tend to retreat nodes and breast/chest giving 50/25 to nodal regions and 45/25 to breast/chest wall. If <5 years, I consider treating regional nodes (axilla, SCV) only.
What is the best way to compensate for hypofractionated radiation interruptions due to COVID?
While missing a day or two here or there in these ultra hypofractionated courses should not make a huge impact, facilities should be capable of continuing to treat the (hopefully rare) COVID positive patients in their clinic, at this point in the pandemic. Treat COVID positive patients at end of th...
Do you re-test patients who test positive for COVID-19 during or prior to starting cancer treatment?
Here is a summary from the CDC website supporting a 'symptom-based' approach with self-quarantine for ~10-14 days after symptoms (perhaps 21 if severely immunocompromised or severe COVID symptoms) without need for a negative test. From: https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolati...
Would you give RT to an ulcerated resected T2 BCC of the perianal margin, with close margins, and no anal canal involvement?
No, this is a favorable histology with an extremely low nodal metastasis risk and nearly a 100% salvage rate with definitive radiation. Any long term toxicity would be hard to justify and could come with medicolegal vulnerability.
What dose and volume(s) would you consider for a young woman with an axillary nodal recurrence from breast cancer s/p TBI as well as chest wall (only) radiation?
I would consider RT to the undissected axilla and supraclavicular region and limit the dose to 45 Gy in 25.
Do you consider cystic fibrosis a contraindication to lung SBRT for primary NSCLC or oligometastases?
Just when you think you've done every odd thing in thoracic RT... I have never done RT on a patient with CF. The median survival, according to Dr. Google (advanced edition), is around 40 years which is most likely why I haven't seen that presentation. Double advanced Dr. Google (scholar.google.com) ...