Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat an elderly patient with a well-lateralized large (ie. cT3) node negative oral tongue cancer, who is not felt to be a surgical candidate?
Would favor EBRT followed by HDR interstitial boost, if feasible.
Would you consider eliminating post lumpectomy RT in a premenopausal patient with pCR after chemotherapy for a cT1cN0 triple negative breast cancer?
We don't have any prospective data on omitting RT in this case and would not consider this approach for triple negative patients.
How would you treat an early stage rectal adenocarcinoma in a patient that had previously received EBRT prostate radiation?
Surgery.
What dose and fractionation would you recommend for palliative-intent radiation therapy for cutaneous angiosarcoma in a patient with distant metastases?
For a patient with a fairly short time horizon, 30/10 is totally defensible and appropriate. Small series have reported on a variety of other palliative regimens, for example:39 Gy/13 fxQuadShot I think one could also consider 5 Gy x 5 or 6 Gy x 5, as we know both of those are safe even in the preop...
How do you decide on the elective radiation volume when treating a lateralized node negative non-tongue oral cavity cancer with definitive chemoRT?
I recommend surgery with/without postop RT unless medically inoperable. With curative intent, use brachytherapy or intraoral cone for the boost to shorten the overall time. Irradiate contralateral neck if within 1.5-2 cm of midline.
Would you be comfortable with patients taking Juven protein powder during head and neck radiation?
Heavy in antioxidants, no. Otherwise ok.
Do you recommend patients wait to have a total hip sx after salvage radiation for RP?
No, I would not require a waiting period because of the total hip replacement. I standardly use IMRT and we typically avoid incoming beams through artificial joints anyways because of the attenuation. Thus, more likely to use a static multi-beam plan than VMAT if the patient has an artificial hip. U...
How would you approach a patient with well controlled metastatic lung cancer who develops a new primary P16 positive oropharyngeal squamous cell carcinoma?
Multiple primaries are not uncommon. Given tremendous advances in treatments of advanced lung cancer and consequent improvement in overall survival, it is important to focus on screening, early detection, and curative-intent of other cancers whenever applicable. This seems to be one such situation. ...
Would you offer adjuvant radiotherapy to an elderly patient with T4 SCC of the scalp and positive margins 6 months after Mohs surgery?
I would most certainly offer RT in the presence of a non-healing wound. A wound that has not healed in 6 months is almost never going to heal by itself. First up with a non-healing wound, one must suspect a recurrence – even in absence of confirmed biopsy. There are so many instances I have seen peo...
Would you offer RT alone to an elderly woman with squamous cell carcinoma in-situ of the vulva, distal vagina, and periurethral area?
I have had such a patient; multiply recurrent over a relatively large field such as this case. I gave her RT alone (45-50.4Gy) to central structures with large margin (no nodal treatment) and she was recurrence free for 5 years (last time I saw her).