Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose fractionation would you recommend for large (>5 cm) perianal Bowen's disease (squamous cell CIS)?
I think that peri-anal lesions such as this (and most invasive anal skin cancers as well) are almost always better managed surgically. It would be the very rare patient who would not tolerate the surgery but would tolerate an aggressive RT course directed to the anal/perianal lesion. If put in some ...
Would you consider catheter-based APBI in the setting of a recurrent Stage I breast cancer in a patient who has received whole breast radiotherapy and is refusing mastectomy?
I have done case by case based on affect of previous RT on breast and expected cosmetic and disease outcome after re-irradiation. Our default preference for patient suitable for re-irradiation is 1.5 BID to 45 Gy treating partial breast like RTOG study although in few patients have used balloon base...
Is NF1 an absolute contraindication to intracranial radiation in pediatric gliomas?
I would consider a relative but not absolute contraindication. While we try to avoid radiation for NF1 patients with intracranial brain tumors because they tend to be more indolent, more responsive to systemic therapy and patients have pre-existing neurocognitive issues, radiation is sometimes the b...
How do you manage systemic therapy with SRS for brain or spine metastases?
This is an interesting and challenging question with limited data and a high degree of variability among providers. Thus clinical practice patterns and preferences vary even among our institution. For Gamma knife/intracranial SRS, the range of time with immunotherapy and targeted agents varies at ou...
Would you ever recommend a breast boost using BID fractionation due to patient scheduling?
We don't usually give the breast boost BID (due to patient scheduling or other reasons) but we will deliver a daily concomitant boost (270cGy to whole breast with simultaneous integrated daily boost of 320cGy to tumor bed for total dose of 4050cGy to whole breast and 4800cGy to tumor bed) as per our...
How do you manage a soft tissue sarcoma arising from neurofibromas (NF1)?
Great question! Sarcoma (STS) arising in the setting of NF1 can be challenging.I usually recommend for preop XRT, image-guided RT for STS should be 50 Gy in 2 Gy/fx:GTV = MRI T1 plus contrast imagesCTV for Intermediate-to-High Grade Tumors ≥ 8 cm: CTV = GTV and suspicious edema (defined by MRI T2 im...
Are prostate PET scans (axumin, PSMA, etc.) still useful for patients on androgen suppression therapy?
The detection rate with this radioisotope is a function of PSA level with sensitivity improving with increased level of PSA. I don't think androgen ablation by itself would affect detection rate unless disease is under control with the therapyThis is good review article in PRO comparing sensitivity ...
Is there a role for radiation therapy if squamous cell carcinoma (SCC) is incidentally found in an excised epidermoid cyst?
My inclination would be no postoperative treatment for this patient. An encapsulated, completely excised, incidental SCC tumor has little likelihood of local recurrence.
How would you manage a recurrent chest wall desmoid tumor?
Generally for desmoid tumor, we reserve RT for two situations (1) as preop for recurrent desmoid tumor where resection is planned typically to 50 Gy in 25 fractions similar to STS or (2) as definitive treatment for symptomatic/progressive unresected tumors, typically to 58 Gy. Because the difference...
What is the role of neoadjuvant breast radiation in patients with triple negative breast cancer progressing on AC-T?
There is no standard treatment in this setting. If a patient is not a candidate for clinical trial, we have been doing RT with concurrent carboplatinum or xeloda with the hope of making the disease operable. In our experience, response is mixed with a set of patient making it to operable stage.