Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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.
Are there any special considerations when giving breast radiation to a patient with Sjogren's syndrome?
I have not adjusted my dose/fractionation or approach for patients with Sjogrens. I have also offered both WBI and PBI.
Are there any situations in which you would treat a cutaneous in-situ squamous cell carcinoma of the head and neck with radiation?
Primary radiotherapy (RT) is generally not indicated for carcinoma in-situ (CIS) or pre-invasive malignancies for which surgical resection aimed at achieving negative margin is the mainstay approach. Even if the patient were inoperable or the tumor was unresectable (two distinct scenarios), active s...
Do you offer patients BID treatment days during holiday weeks with only 3 business days?
My old practice would treat curative patients on the Sunday before Thanksgiving to allow for the longer weekend (Th - Sun), thereby getting patients 4 treatments for the week. There is the consideration of a 4 day break, but it's radiobiologic theoretical concerns, and I'm unsure that anyone would b...
What is your preferred CSI dose/fractionation for leptomeningeal disseminated low-grade glioma?
When treating leptomeningeal dissemination (LMD) of low-grade glioma (LGG) with craniospinal irradiation (CSI), radiation doses vary depending on the patient's age and clinical situation. While definitive dosing is still being investigated, established ranges from clinical practice and studies provi...
When do you consider consolidation chest radiation in a patient with stage IV non-small cell carcinoma of the lung who has had good response to systemic therapy?
It's a really great question, and it comes up a lot in our tumor boards and general practice. There are a couple of paradigms that I use to help me think through when and how to do it. I would say the data here for the use of RT is mixed, and either gives you freedom to do a variety of things or giv...
How would you manage a pT2N1a invasive ductal carcinoma s/p lumpectomy and sentinel lymph node biopsy with ECE, and two mildly avid axillary lymph nodes on post-op PET/CT?
We often see mildly active lymph nodes on post-op PET/CT scans, so one important initial question is how long after the surgery the PET/CT was performed. Another question would be how many total lymph nodes were removed at the sentinel biopsy. If the scan was done ~6 weeks post-op and the patient ha...
How do you approach postoperative radiation therapy in a patient with head and neck cancer who has high risk of recurrence in the setting of active epidermolysis bullosa?
Epidermolysis bullosa is a rare genetic entity characterized by collagen mutations affecting the attachment of epithelial cells to the basement membrane of the skin and mucosa, manifesting in blistering and non-healing skin wounds and mucosal strictures in the GI tract. There is a risk of non-healin...
How, if at all, does your practice differ between male and female breast cancer patients with respect to the use of bolus?
Not sure if I understand the question. The skin is not the target here; it's the chest wall. Contour it and cover it. Without an indication for increasing skin dose (T4 disease, etc.), I'm not sure of the value of bolus in either men or women.
In what situations would you recommend adjuvant radiation therapy for patients with locally advanced and/or recurrent basal cell carcinoma that receive vismodegib followed by surgery?
Adjuvant radiation therapy should be considered for locally advanced basal cell carcinomas when surgical margins are positive, or when there is perineural invasion, particularly in high-risk anatomical locations such as the face. This recommendation is endorsed by both the NCCN and the American Acad...