Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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.
What approach do you take to determine dose constraints for SBRT reirradiation of the head and neck?
There is likely no "safe" dose when delivering full-dose SBRT overlapping tissue that previously received 40-70 Gy. The best you can do is make sure the patient understands the risks, that this strategy fits their goals of care, that you've considered all alternatives, and that you approach planning...
When starting HN radiation, which start day do you prefer to add most value to the treatment course?
Not sure there is really strong data on the preferred day to start. With a 35 conventional fraction HN plan, starting on a Monday ends on a Friday (assuming no holidays or missed treatments). With the same assumptions, starting on a Tuesday ends on a Monday, etc. So personally, haven't been dogmatic...
What is the role for molecular agents alone for medically inoperable NSCLC who is not a good candidate for chemoRT?
If medically inoperable and deemed not a chemo candidate, my preference would be definitive RT alone using a hypofractionated approach to account for the absence of radiosensitizing chemotherapy even for patients with targetable driver mutations. The best data we currently have would then say to con...
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. ...