Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage early stage I uterine serous carcinoma?
The management of these patients remains controversial. The data are conflicting and treatment choices tend to be based more on impressions than solid data. Most clinicians advocate chemotherapy although randomized trials have not clearly shown benefit for this subset. For stage IA, we typically tre...
Would you offer a third course of palliative radiation after two courses of 8 Gy in 1 fx?
Hip pain can mean different things - is it the ilium, ischium, acetabulum, femur, or L-spine causing the pain?If it is the exact same bone as previously treated, a third fraction of 8 Gy can generally be safely given over the course of 4 years, especially if pain relief each time has lasted ~2 years...
Do you recommend re-excision of a unifocal positive anterior margin at skin after lumpectomy in a patient with otherwise low risk breast cancer features?
There are few data on how margin location affects outcome. A group from Dundee and Perth in Scotland reported that re-excision performed for an anterior margin of less than 1 mm found residual disease in only 4% of patients who had initial excision in the subcutaneous plane, compared to 24% of patie...
Do you offer partial breast irradiation to women with tumors infiltrating the dermis (not epidermis) who otherwise fall in the "suitable" ASTRO category?
I have not done APBI in a situation like this.
Do you consider chest wall constraints when treating with 5-fraction APBI?
We don’t have specific for chest as following APBI dose constraints keeps it within acceptable limits if chest wall is part of PTV.
Would you offer APBI to a patient with very large breast anatomy and a small lumpectomy cavity after an oncoplastic closure?
I would offer it with the caveat I always offer APBI candidates which is that final suitability will be determined at sim to ensure the surgical bed is evident and suitable for APBI. The breast surgeon will mark the tumor bed with clips and if the closure hasn't disrupted or dispersed the clips, APB...
Is there a role for induction chemotherapy for locally advanced head and neck squamous cell carcinoma prior to definitive chemoradiation?
Induction chemotherapy can be considered in some patients with locally advanced SCCHN, primarily those patients with large bulky tumors who are at highest risk for developing distant metastases. Moreover, if you are looking to attain reduction in tumor bulk for symptom control and possibly control o...
Would you offer neoadjuvant radiation therapy with concurrent chemotherapy for a T4 rectal carcinoma with an associated rectovesical fistula?
In the past, some considered fistulas to be a contraindication for radiation therapy due to concerns about potential worsening. However, our understanding has evolved, particularly in cases where the tumor itself is often the primary cause or a significant contributor to the fistula. Consequently, i...
Would you consider testosterone replacement therapy in a symptomatic, hypogonadal man with a history of prostate cancer?
I would strongly consider TRT in men with a history of treated prostate cancer. If he has undetectable PSA 3 months post treatment, testosterone replacement is likely safe, does not increase risk of recurrence of cancer, will improve sexual symptoms, may improve cardiovascular risk factors, and musc...
How do you apply the concept of a lumpectomy bed boost in the setting of oncoplastic surgery?
This is a very common and often frustrating issue in patients I absolutely feel the need to boost (younger, larger tumors, high grade). I now consistently request my surgeons place a 3D tissue marker (brand name Biozorb) which preserves the location of the lumpectomy despite oncoplastic reconstruct...