Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When contouring pelvic lymph nodes in rectal and anal carcinoma, do you exclude bowel from your CTV?
Certainly, the expected clinical difference is so small that I personally think we will never have data to tell us whether one strategy is better than the other. Another point to consider is that unless your bowel constraints are very strict, your planning process is going to allow a considerable am...
Would you recommend XRT to post-cystectomy bladder cancer patient with metastatic PA and mesenteric nodes?
I would not as this would have outcome like metastatic disease and need systemic treatment as the mainstay of treatment.
What is the significance of entrapped nerves present on pathology for oral cavity cancers?
For oral cavity, surgery and postop RT. For oropharynx, RT chemo. It’s very uncommon.
What is the clinical benefit of primary site postoperative radiation after neoadjuvant chemotherapy and oncologic surgery for an extremity soft tissue synovial sarcoma in an oligometastatic patient with pulmonary metastases ?
Management of oligometastatic soft tissue sarcoma is an interesting problem without a uniform standard of care. Institutionally, we often treat these patients in the following sequence: neoadjuvant chemo, then neoadjuvant concurrent chemoRT to primary site, then consolidate the oligometastatic sites...
Would you offer reirradiation after resection of locally recurrent triple negative breast cancer only 6 months after completion of postmastectomy radiation?
If recurrence is in the prior full dose of RT then get concerned about the efficacy of reradiation when it didn’t work 6 months ago. If it is marginal area or in an area where dosing was inadequate, then yes. Also if have hyperthermia then it would be a good modality to add with reradiation in this ...
Would you offer RT for a patient with early stage breast cancer with a focally positive margin who was lost to follow up for over a year after surgery?
It’s too long of an interval for any benefit of adjuvant treatment. Needs mammogram and follow up along with relevant systemic therapy.
Would you offer PMRT to an ER/PR+, Her-2 negative cT3 tumor treated with neoadjuvant chemotherapy, but with a minimal treatment response?
The data on the risk of local-regional failure and the effect of PMRT on outcome are still too limited and contradictory to be certain of the correct answer. For example, the 10-year risk of LRF in the NSABP series of 95 cT3N0 patients having negative nodes but residual breast disease was 12% (1). H...
Would you recommend PMRT for stage IIA (pT1c pN1a) ER+/HER2- grade 2 IDC in an elderly patient with a single positive non-sentinel lymph node?
Agree, no PMRT reasonable given patient age, lack of LVI, low Oncotype, pre-op US showing no abnormal axillary LAD, small G2 tumor, small LN met, and lack of ENE. That said, I don't think offering PMRT with hypofractionation as suggested above by @Dr. First Last is unreasonable (in fact, though this...
For patients with peritoneal carcinomatosis and minimal response to neoadjuvant chemotherapy, is there a benefit to palliative cytoreductive surgery followed by whole abdominal radiotherapy?
The prognosis for individuals with peritoneal carcinomatosis is generally bleak. Administering radiation therapy to manage gastric, colon, or appendiceal cancer is exceptionally challenging due to the imperative to safeguard the delicate large and small intestine. One potential exception arises when...
Would you order a DEXA scan for a cervical cancer patient with osteoporosis?
This is a great question and one that we should all be contemplating. I do order Dexa scans on all of my post-menopausal patients if they have not had a current baseline. Many of them have lifestyle issues that could also have decreased bone density such as low weight, tobacco and alcohol use, etc. ...