Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach H&N radiation in a patient who recently had carotid endarterectomy (cancer incidentally found during surgery)?
I’m guessing in a lymph node. It would depend on the location. External jugular think skin. Internal jugular think mucosa. Close, heal, work up for unknown primary. CT and PET. Check path for HPV. Treatment depends on whether it’s likely a mucosal vs skin primary.
In what situations do you utilize motion management of the optic structures?
A paper published in Br J Radiol. 2019 (Xiang et al., PMID 31067077) showed, based on MRI, an average physiological motion of the optic chiasm to be 0.5-0.75mm. We have used at least 1mm expansion of the optic nerves and chiasm in our stereotactic radiosurgery treatment planning.
Would you consider definitive RT in a patient with oligometastatic bladder cancer who is not a surgical or chemotherapy candidate?
Oligometastatic bladder cancer has quite a poor prognosis and most local treatment in this setting is palliative in nature. Durable local control that provides hemostasis and prevents obstruction and other urinary issues is crucial. 30/10, 40/15, 55/20 are all potential options, but knowing that thi...
How do you approach management of a young inflammatory breast cancer patient after a CR to neoadj chemo but refuses surgery?
I would first review the NCDB study showing the best outcomes for trimodality therapy (Reuth et al). Then explore why. If it is a belief CR means cured highlight imaging can be discordant. There will often be cancer found at surgery. If there is a pCR that is the best chance for cure but even with t...
How will you counsel patients receiving radiation therapy regarding COVID-19 vaccine administration?
Encourage to take the vaccine as scheduled (both during or after RT).
Is there a role for RT in localized nodal relapse of stage IV follicular lymphoma with the goal of delaying the need for additional systemic therapy?
Indolent lymphomas like follicular lymphoma typically present with diffuse disease and therapy for the disease is not curative. Oncologists vary in the aggressiveness of their treatment approach, but almost all medical oncologists would advocate for administration of systemic therapy before the pati...
Do you avoid adding high energy photons (with associated neutrons) for younger breast cancer patients, out of concern for secondary malignancy risk?
We used mixed, whenever appropriate, with optimization of dose distribution using field within field technique (no wedges).
How would you approach an early inguinal recurrence after surgical resection of Merkel Cell carcinoma in the popliteal region?
I would make sure there is no distant metastases with a PET-CT. Would try to enroll this patient in a trial. Current approach if localized in surgery followed by radiation, but with availability of immunotherapy, I would recommend at least an adjuvant immunotherapy after surgery. No one knows if rad...
How would you treat and delineate target volume for a pT1N2 NSCLC after wedge resection with clear margins?
In a patient who has undergone a wedge resection and who has negative margins, I do not see an indication for radiotherapy to the residual primary site or staple line, inasmuch as the surgical approach is not standard of care in operable patients. If wedge is done in a high risk operable patient, I ...
How would you approach the treatment of a patient with a history of cutaneous melanoma and only overt site of disease being a bulky level III axillary lymph node?
Surgery and postop RT.