Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage an isolated nodal recurrence of breast cancer in a patient with a prior history of mantle-field radiation?
The clinical details of the patient's "initial" radiation-associated breast cancer and what adjuvant treatment(s) she received after her mastectomy and reconstruction would be helpful here, both in determining the risk of the nodal recurrence she has now experienced and what additional therapies she...
What is your approach for testing speech in bilingual patients undergoing an awake craniotomy for glioma resection?
In a bilingual patient, it is important to assess the patient's language function in both languages. This would include pre-operative non-invasive functional mapping as well as intra-operative awake mapping. Areas of language function and connectivity are less discrete than sensory and motor functio...
What is your approach to prescribing gabapentin for oral mucositis prophylaxis during chemoradiation?
It can be a useful adjunct therapy, especially for patients getting radiation for oral cavity cancer. Randomized trials have been conflicting but some have shown benefit in a prophylactic setting. In my experience, patients tend to need less narcotic medication (usually able to get by with gabapenti...
Given UK FAST Forward data for whole breast, would you consider this daily 1 week fractionation scheme when treating with partial breast approach?
I use the Livi regimen daily rather than other day and it has worked well. I use IMRT. You could also consider 27/5 based on ACCEL study, though follow-up was short.
What is the role in your clinic for chest imaging in head and neck cancer patients who are free of local disease 1+ years after treatment?
Our multidisciplinary team continues to discuss this controversial area. We tend to obtain annual low-dose non-contrast CT chest scans for 5 years in patients with N2-N3 disease regardless of smoking status, if they would be healthy enough to undergo therapy for metastatic disease. In current/former...
Are there any specific high risk features or situations for which you would offer adjuvant radiation to a newly diagnosed benign pleomorphic adenomas following resection?
In the non recurrent (upfront) setting, it is not popular to jump to post op RT. The main rationale for using RT in a relatively benign disease is if there is a high probability of recurrence based on certain characteristics such as intra operative spill, unresectable gross residual disease etc AND ...
How do you treat a large, resected ex pleomorphic adenoma with unknown margin status due to tumor fragmentation?
Treat the tumor bed to 60-66Gy, no systemic therapy needed.
What are the indications for adjuvant radiation for a resected intracapsular carcinoma ex pleomorphic adenoma of the parotid?
It is unclear to me how the "intracapsular" component would change management since I am not familiar with this entity. However, carcinoma ex pleomorphic adenoma is a high grade cancer and merits PORT. If neck is pN0 after an adequate dissection, theoretically does not need treatment. In treating ...
Is it safe to deliver palliative spine radiation concurrently with sacituzumab govitecan?
There are simply not enough data to confirm the safety of concurrent sacituzumab govitecan and RT. As palliative spine RT typically entails a short course (cEBRT using 8 Gy in 1 fx or 20 Gy in 5 fxs or SBRT using 2-3 fractions) of treatment, holding the medication for a week during RT should not imp...
When do you use a vaginal cuff boost with pelvic RT for stage II endometrial cancer?
Most prospective studies studying the role of external beam in endometrial cancer have treated patients with pelvic radiation (46/2 Gy or 50.4/1.8 Gy) without any brachytherapy. These studies have reported very low rates (2-3%) of in field failure in the radiation arms, so recommending external beam...