Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For low rectal adenocarcinoma that extends to the anus through the internal sphincter muscle, would you recommend neoadjuvant therapy in a patient who will undergo APR?
Yes, since the margin is positive and local recurrence rates are high for low rectal cancer patients such as this, they should be treated with neoadjuvant chemoradiation including the inguinals with IMRT.
When would you recommend adjuvant therapy for a patient with urethral adenocarcinoma after partial urethrectomy?
My first approach in this setting is to have the pathology reviewed by an expert tumor pathologist, and to be sure of the T stage, margins, N/M stage, and whether any tumor markers are heavily expressed. If there is a strongly expressed tumor marker, such as CEA, I will obtain baseline, and interval...
In breast cancer patients with a positive margin on permanent tissue but not on frozen, do you recommend re-excision or just proceed with radiation?
We would favor re-excision as the risk of IBTR is high.
What is your approach for a symptomatic inpatient with locally advanced NSCLC who cannot have a PET?
These are tough cases. While we ideally aspire to have full (and congruent) staging information, this is not always possible.There are therefore competing pressures. Factors that favor AP/PA, 3 Gy fractions include 1) the need to initiate treatment rapidly given symptomatic burden and 2) the desire ...
How do you approach SRS for brain metastases in the setting of a connective tissue disorder such as lupus or scleroderma?
Historically, connective tissue disorders (CTD) have been considered to be a relative contraindication to radiotherapy generally - due to concerns of potential increased risk of complications. Data on this issue is somewhat conflicting. In the setting of SRS for brain metastases or brain tumors, the...
Is there a role for SBRT with vaginal melanoma?
With proximity of rectum, urethra, and vulva, we favor 3DCRT or IMRT to 45-50 Gy at 2.5 Gy per fraction with and without brachy based on response.
Would you include ipsilateral nodes in adjuvant RT for bulky Mammary Analogue Secretory Carcinoma of salivary gland?
I assume that the bulky lesion was dissected, likely by superficial parotidectomy (if it arose in the parotid gland), and that postop RT is indicated in this low-grade tumor due to positive/close margins or facial n involvement. While the risk of LN metas is small, the inclusion in the targets of ip...
For a chest wall scar boost with a very long scar that requires 2 electron fields, how do you do that clinical setup?
If need be, I have used abutting/matching electron fields (match on skin).
What is your approach following R1 resection in a patient who has received total neoadjuvant therapy for rectal cancer?
This is a challenging scenario and there is not a one-size fits all solution. My decision making would involve thorough assessment of the patient's performance status, co-morbidities, pre-treatment extent of disease, tolerance of therapy, and review of what TNT regimen was employed: number of chemo ...
How do you approach fertility preservation in a young child with cancer?
After the diagnosis is known, we meet with the families to discuss the known risks for infertility based on what we know about the treatment regimen they are to receive. For example, a patient with Ewing's sarcoma will receive high dose alkylators and therefore, is at significant risk for future inf...