Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer adjuvant chemotherapy for a large, high-grade radiation-induced malignant peripheral nerve sheath tumor following R1 resection?
I assume a post op scan shows no gross disease. Technically this is not "adjuvant" since there is known microscopic residual disease. In a young patient with good PS and organ function, it's reasonable to discuss risks and benefits of systemic chemotherapy (Doxorubicin + Ifosfamide) now vs. close f/...
What PTV dose heterogeneity do you accept for head and neck radiation plans?
Around 10% but then I'll take the optic chasm to 70 Gy plus in order to adequately treat the tumor. I have a patient under treatment now in that situation. So I do what it takes. If it requires more heterogeneity, so be it.
What margins (CTV and PTV) do you use for boosting breast lumpectomy cavity?
RTOG says: Contour seroma/architectural distortion/relevant clips/lump scar as GTV. Add 1cm expansion for CTV, posteriorly carve til anterior to pec major and don't cross midline; pull into skin 5mm. Add 0.7cm expansion for PTV but exclude heart. Then create PTVeval - pull PTV into skin 5mm, don't ...
Do you give adjuvant RT to vulva in a patients with node positive vulvar cancer and no high risk features for vulvar recurrence?
There is variation in practice. I tend to treat primary also along with nodal volume as long term data shows a 25- 35% risk of LR and a low 65% salvage rate. Data unknown is how much would RT reduce this and if these are true recurrences or new primary. Te Grootenhuis et al., PMID 26428940
In what situations do you consider radiation to the pelvic and inguinal lymph nodes without treatment of the primary in vulvar cancer?
Good data in vulvar carcinoma is rare as there are not very many patients and not very many studies. Having said that, there is some data available.Among the literature is a 1994 Red Journal Article by Duesenberry et al. This is a study of 27 vulvar patients of which 13 patients had recurrences in t...
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...
What are your top takeaways in Sarcoma from ASCO 2026?
I really enjoyed the panel presentation “Unique Challenges in Sarcoma Care for Adolescents and Young Adults", (Jessop et al., ASCO 2026). I also enjoyed “A Multidisciplinary Case-Based Approach to Non-Rhabdomyosarcoma Soft Tissue Sarcoma in Adolescents and Young Adults: Challenges and Emerging St...
How do you counsel patients on the risks and benefits of chemotherapy or radiation offered with palliative intent?
Before I start counseling a patient on these decisions, I want to know a few things first. I would want to know from the oncologists what they think the benefits are (i.e., how much more time might they get? Symptom control?) and what the risks are. The chances that the patient will see a benefit. ...
How do you weigh upfront nodal burden when deciding to omit PMRT in a patient with cN1, ypN0 disease after neoadjuvant chemo, mastectomy and ALND?
Pre-chemo imaging if it shows 4 or more abnormal nodes (N2) then would offer RNI irrespective of response.
For T1b or T2a NSCLC cancer, approached with SABR, should chemotherapy be considered in the adjuvant setting?
It is not standard of care to give adjuvant chemotherapy in IA NSCLC.It can be considered in certain situations of stage IB, although there is no strong prospective data. The group with > 4 cm size tumars had some benefit in an unplanned subgroup analysis of the CALGB study. If other risk factors be...