Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you add elective nodal radiation for high-grade myoepithelial carcinoma of the hard palate in addition to adjuvant radiation of the post-operative bed?
Yes
What dose objectives and constraints do you use for hypofractionateed whole breast irradiation?
The most important goal is dose homogeneity. We aim for V110 (volume of breast getting 110% of prescribed dose) to be zero and V105 to be less than 10% with no V105 in the inframammary or areolar regions. For the heart, we aim for a mean dose 1-2 Gy with no beam going through heart so that the only ...
Would you recommend PMRT in a male patient with a T2N0 breast cancer?
In the absence of strong data for men, typically the adjuvant recommendations are extrapolated from the women's literature and node positive patients appear to benefit from PMRT. This SEER analysis is the most robust dataset published, thus far. N0 patients do not appear to benefit, so unless this p...
Would you treat a patient with definitive local XRT without systemic therapy if he/she presents with pathology showing a PTCL NOS from a small (1.5 cm) lesion of the skin of the chin?
For background, there are several T-cell primary cutaneous lymphomas. Several are treated routinely with radiation therapy alone, including primary cutaneous anaplastic large cell lymphoma (ALCL) and primary cutaneous CD4 positive small/medium T-cell lymphoma. Other T-cell primary cutaneous lymphoma...
What treatment do you recommend for patients with Siewert III gastroesophageal junction cancer with periesophageal or mediastinal lymph node involvement beyond what is considered regional for gastric cancer?
Patients with non-regional lymph node metastaseshave stage IV disease by definition and should be treated with palliative chemotherapy. There is no defined role for chemoradiation in this setting. However, in rare instances (e.g. young patient with excellent functional status and minimal non-regiona...
How would you manage a short-interval (0-3 months) failure in the untreated para-aortic region after definitive treatment of locally advanced cervical cancer?
The current paraortic disease could perhaps be an area near the edge of the prior pelvic XRT filed. Since this is the only area of disease now and given short 3 month interval, it is reasonable to give CHEMORADIATION AND TRY TO BOOST THE GROSS DISEASE.
What are your radiotherapy recommendations for a unilateral primary intraocular large B-cell lymphoma following high-dose methotrexate and rituximab?
Primary intraocular lymphoma is quite rare without standard treatment guidelines. As PCNSL often involves the globe, at initial diagnosis and/or at relapse, I view isolated intraocular disease as a subset of primary CNS lymphoma. HD-MTX regimens are typically utilized. As the disease is localized, c...
How do you manage patients with locoregional lymph node recurrence after radical cystectomy for muscle invasive bladder cancer?
Recurrent bladder cancer is typically a systemic disease. I would start with cisplatin based chemotherapy first and then add consolidative radiotherapy. There is a small body of literature on surgical consolidation as well. In our single instiution experience patients did very well following radioth...
What dose-fractionation and technique do you use when treating lentigo maligna?
57.5 Gy/23 fractions using superficial (100 kv) radiotherapy in most situations, as long as the target is not too large. There are a variety of dose fraction schemes used which are generally dependent on technique (Grenz, orthovoltage, skin surface brachytherapy, megavoltage electrons), but this is ...
Would you offer preoperative radiotherapy for muscle-invasive SCC of the bladder (catheter associated)?
The use of pre-operative radiotherapy for locally advanced bladder cancer has not been routinely utilized or part of the standard of care. That being said there is a long history of tri-modality bladder preservation therapy in which pre-operative chemoRT has been utilized and radical cystectomy util...