Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What treatment would you recommend for DCIS incidentally found in pathologic specimen following breast reduction surgery?
This is a challenging situation that can be seen in spite of evaluation prior to definitive procedure. I would agree with an MRI after the patient heals to look for any obvious residual disease. In the absence of a completion mastectomy which is usually unlikely, I would favor a course of whole brea...
Are there any potential benefits to irradiating the partial breast with an MR-linac over conventional linac?
The group at WashU has done a great job publishing on this topic (Price et al., PMID 34624406).At this time, I don't think we can say there is a clear benefit to MR linac over conventional CBCT when it comes to cancer control or toxicity, though there may be dosimetric benefits (that could translate...
What is your approach to adjuvant vaginal cuff radiation in patients with prior definitive pelvic radiation therapy?
I do take the previous dose into account. Sometimes use a multichannel cylinder and try to control the rectum and bladder dose. Also, prescribe lower end of acceptable dose schedule like 6 Gy x 5 to surface or 4 Gy x 6 to surface.
In a patient with rectal adenocarcinoma and involved gluteal lymph nodes, what would your elective lymph node volume include?
I think the most important issue to address in this case, is how disease accessed the subgluteal space. I had a case like this in a patient with a very deeply invasive disease. During chemoRT, the patient required a diverting ileostomy after they developed a recto-cutaneous fistula due to rapid tumo...
How would you sequence treatment of a synchronous IC1 high-grade serous ovarian cancer and cT3N1 rectal cancer?
Do you dose escalate a patient with high risk prostate cancer who refuses ADT due to potential side effects?
I would treat the elective pelvis to around 50 Gy with a simultaneous boost to the LN to as high as tolerable based on proximity to the bowel. The prostate should be taken to normal dose-escalated levels depending on your fractionation, and you can add a microboost to a DIL. I generally do not add a...
Is polymyalgia rheumatica associated with increased toxicity for lung SBRT?
No data here that I can speak to. Lung involvement is exceedingly rare in PMR and generally, I wouldn’t consider this a disease associated with increased risk of inflammatory response within the lung parenchyma. There are some reports of associated GCA, BOOP, and other interstitial lung findings in ...
What is your approach for treating oligometastatic head and neck cancer to an adjacent nodal site (ie. axilla, mediastinum etc.) with radiation therapy?
If limited chemo RT with curative intent.
Would you hesitate to give breast radiation to a patient with prior near-fatal Stevens Johnson medication reaction?
Although this is an extremely rare occurrence when looking at the literature on this subject, limited to case reports/series, I think that I would hesitate to give breast RT in this case. This is based on the fact that in this case, it is DCIS that is being treated, and despite the DCIS being recurr...
Is there a time interval after which you would not offer adjuvant radiotherapy for a malignant, grade 3 meningioma?
Adjuvant radiation for grade 3 meningioma is based on prior observational studies that generally reflect recurrence rates approaching 90% for grade III disease, and the insufficiency of salvage treatment approaches.Given the small numbers of grade 3 tumors, and the heavy bias towards upfront postop ...