Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In clearly resectable pancreatic adenocarcinoma with no arterial or venous involvement, is there a role for neoadjuvant chemotherapy?
There is currently equipoise regarding this question, and the Alliance A021806, a phase III trial evaluating perioperative versus adjuvant therapy for resectable pancreatic cancer, clinical trial will address it. There is a role in certain subsets of patients without clear vascular involvement regar...
Should special precautions be taken patients with Ehlers-Danlos syndrome receiving radiation therapy?
Not all EDS is the same. Most commonly, an EDS patient these days is a clinically diagnosed patient with hypermobile joints, possibly stretchy skin, and possibly chronic pain syndrome. That is a very different picture from vascular EDS with a COL3A1 mutation, which is rare and would have the extreme...
After wide local excision of a DecisionDx-SCC Class 2A cutaneous SCC of the posterior inferior scalp, would you irradiate nodal basins?
Yes, if I were going to irradiate the operative bed. I do not know prospective data on the use of adjuvant radiotherapy for nodal basins only in squamous or basal cell skin cancers, Cf. Porceddu et al., PMID 25993217, where a minority (5%) of patients are at risk for relapse, typically locally or re...
What total dose do you use for a close and positive breast cancer margin that cannot be re-excised?
Based on consensus guidelines, there is no such thing as a close margin as HR for recurrence did not change based on margin width. That was the reason for group to conclude that no tumor at inked margin is a negative margin (except for pure DCIS or those who had neoadjuvant chemo).If we give a boost...
Is prior whole brain radiation and/or spinal radiation within last 6 months a contraindication for intrathecal methotrexate treatment in with leptomeningeal disease?
We treated a few patients with leptomeningeal disease with palliative RT in conjunction with IT MTX in our institution, with RT delivered safely within 1 week of IT MTX without any apparent increase of clinically significant toxicities. There are no high-quality data to suggest that palliative RT is...
What is the minimum amount of time you should wait between a TURP and the start of definitive prostate radiation therapy?
I am not aware of any solid data on which to base an answer to this question, however, it is a problem that still occasionally arises. A recent summary of the data pertaining to the risk of late effects from prostate radiation after TURP, published in the American Journal of Clinical Oncology in Jun...
What head and neck subsites would you treat for a SCC of multiple ipsilateral neck nodes (clinical ECE, no contralateral nodes) with unknown primary origin site despite full workup?
Oropharynx, bilateral neck, ipsilateral RP nodes, and nasopharynx. You could omit the NPX but you’re up there anyway to treat the RPs.
What is an appropriate target volume for a chordoma or chondrosarcoma after a gross total resection?
The CTV for postop chordoma or chondrosarcoma after gross total resection should include the entire surgical resection cavity as well as incision and drain sites with a 1 cm margin for the initial 50.4 Gy. Then cone down off the incision and drain site and cover the high risk margins based on the or...
When treating APBI with the Florence regimen, are you using daily or every other day fractionation?
qD When I started doing this at the beginning of the pandemic, I reached out to the authors of Livi study and they said that despite the study, they were treating every day without issue. Then, they wrote up their series of patients treated qD. It was effective and safe.
What experience do you have with paralysis or myasthenia-like symptoms developing on temozolomide?
This is not an established toxicity of temozolomide and would warrant further investigation.