Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What do you consider to be the regional nodal bed for a Merkel cell carcinoma of the thigh with a positive sentinel node in the inguinal chain?
There's no clear right or wrong answer here - I would favor treating the superficial and deep inguinal nodes, capturing the chain as it extends superiorly and inferiorly with a generous margin above and below the site of the sentinel node. I would probably include the external iliac nodes if this co...
How would you treat a large-cell neuroendocrine carcinoma of the breast with bulky axillary involvement with good response to neoadjuvant chemo followed by mastectomy/ALND?
I would favor comprehensive treatment as uncommon disease and has poor outcome and would err on side of over treatment
What volume would you cover for HPV-positive SCC of level IB node with ECE?
Depending on the subsite and stage of the primary tumor and nodal stage, we may treat ipsilateral IB, II-IV and contralateral II-IV. We may need to cover IV if there is more extensive nodal involvement in the neck. But if we focus the question narrowly on IB node with met HPV(+) tumor with ENE, for ...
Would you ever recommend PMRT to the chest wall alone without nodal radiation for invasive or in situ breast disease?
In patients who are node negative upfront, I do offer PMRT for adverse primary tumor factors which meets criteria for PMRT to CW only. Retrospective data suggest majority of local recurrence in CW in these pts and can skip RNI
How would you treat a woman with an isolated vaginal cuff recurrence from endometrial cancer who has received salvage resection?
I would still consider for RT as limited data suggest higher nodal relapse if only local disease addressed I would treat pelvis with EBRT followed by brachy boost but to lower total dose of 60 to 65 Gy EQ2
How do you approach treatment of metastatic disease involving the brainstem or cervical spinal cord in the setting of prior XRT?
I would look at this scenario taking into account, not limited to, the overall life expectancy of the patient, performance status, cranial and extracranial disease control. I would want to know the prior RT dose fraction, overlap with current target volume, and interval from the prior RT. Suppose th...
For a patient with diffuse large B-cell lymphoma of the testicle, do you irradiate the contralateral testicle alone or do you recommend radiation to the lymphatics and remaining testicle?
The most common clinical scenario for primary testicular lymphoma is an older man presenting with a painless testicular mass who undergoes orchiectomy and is found to have DLBCL. Many patients will have stage I disease with post-orchiectomy PET-CT showing no other sites of involvement. Occasionally,...
What types of supportive care do you offer patients undergoing definitive therapy for their head and neck cancer?
There are multiple team members who help care for our head and neck cancer patients. In addition to the surgeon, radiation oncologist, and medical oncologists, our patients meet with a dentist, speech/swallow therapist, nutritionist, and nursing. During radiotherapy, they meet weekly with the radiat...
How would you treat a patient who had a previous mastectomy for an early stage breast cancer (without XRT) and then develops an isolated axillary recurrence and undergoes ALND?
There are no prospective studies to guide in this regard. Based on retrospective data, I would treat the chest wall, undissected axilla and supraclav area
How do you manage anejaculation following definitive radiation for prostate cancer?
This is a very common side effect of prostate radiotherapy, either with brachy or external beam. Unfortunately there is no "fix" of which I am aware, as the glandular function of the prostate is reduced after radiation (think of the salivary glands and what we know happens to them!). The best option...