Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When would you utilize hypofractionated partial breast irradiation (40 Gy/15 fxs)?
I have done this IMPORT LOW regimen for patients with implant in place, for patients with large seroma, or in patients where APBI is not suitable for cavity to breast ratio, or concern about set up reproducibility.
How many vertebral levels do you choose to treat with post-op RT?
Based on my long term observation/experience and the data from the postop SBRT literature, there is no need to include the whole extent of the surgical hardware. I never did for postop RT or SBRT and never saw a recurrence outside of the involved segment +/- contiguous areas. The international posto...
What dose/fractionation would you consider for SBRT of uveal melanomas too large for plaque brachytherapy?
Stereotactic hypofractionated radiation, and/or high dose proton beam therapy are safe alternatives to eye enucleation in COMS large uveal melanoma patients. Aside from the size of the tumor, dosing can vary based on the modality used for treatment. Although most treatments show good control rates, ...
Does irradiation of a patient with pyoderma gangrenosum carry risk of morbidity similar to necrosis caused by minor surgery?
I have treated a few patients with breast cancer with adjuvant RT with a history of pyoderma gangrenosum on active treatment on immunosuppressive therapy with no untoward acute effects.
In thymoma with R0 resection showing pure thymoma, how would the presence of slightly elevated preoperative AFP and bHCG influence your approach to adjuvant radiation, if at all?
Would not change my recommendation. R0 stage 1, I would observe; R0 stage II-IV, consider PORT with a more tentative recommendation for stage II if high risk histology, close surgical margins, or pleural adhesions. I think in this situation, it may be wise just to check a post-op AFP and bHCG to see...
Is adjuvant RT recommended for a Bartholin's gland SCC s/p piecemeal resection with deep invasion and negative ipsilateral LN dissection?
I agree with Dr. @Dr. First Last that it is a function of margin status. However, with deep invasion and piecemeal resection, I think that margin status would be difficult to determine. A small lesion may be able to be reresected but many times, because of the location in the bartholins gland, the t...
Is it safe to give radiation for early stage breast cancer in a kidney transplant patient who is on Tacrolimus & Cellcept?
Yes, radiation is routinely done in patients with transplant and on immunosuppressive therapy. Efficacy of RT may be reduced in this setting.
Would you offer PMRT to a young woman with high-grade neuroendocrine carcinoma of the breast?
If it is pure high grade NE carcinoma for the above pathology, I would favor observation.
How would you treat a melanoma of the penile skin in a medically inoperable patient?
As above, IO is probably preferred. That being said, I’ve had surprising responses when I thought I was treating palliatively. Although as a group thought to be radiosensitive, it is heterogeneous. I once had a CR with 30/10 in a quite ugly mass (for some reason he got biopsied and no tumor remained...
How do you decide upon a preferred dose/fractionation scheme for breast RT?
Our default fractionation for all situations with or without RNI is 40 in 15 followed by boost, if indicated. If clinically and technically suitable for PBI, then preferred is 6 Gy x 5. Use 50 in 25 if inflammatory breast cancer or poor response to chemo or residual undissected node in IM or axilla...