Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend re-excision of a unifocal positive anterior margin at skin after lumpectomy in a patient with otherwise low risk breast cancer features?
There are few data on how margin location affects outcome. A group from Dundee and Perth in Scotland reported that re-excision performed for an anterior margin of less than 1 mm found residual disease in only 4% of patients who had initial excision in the subcutaneous plane, compared to 24% of patie...
Do you offer partial breast irradiation to women with tumors infiltrating the dermis (not epidermis) who otherwise fall in the "suitable" ASTRO category?
All the randomized trials in APBI suggested that it is more beneficial for low-risk patients, i.e., the SUITABLE in the ASTRO guidelines or very simply the T1No ER+, >50 years old. With a dermal infiltration, it could be an area not receiving the full dose and the patient is not a low risk anymore. ...
Do you consider chest wall constraints when treating with 5-fraction APBI?
We don’t have specific for chest as following APBI dose constraints keeps it within acceptable limits if chest wall is part of PTV.
Would you offer APBI to a patient with very large breast anatomy and a small lumpectomy cavity after an oncoplastic closure?
I would offer it with the caveat I always offer APBI candidates which is that final suitability will be determined at sim to ensure the surgical bed is evident and suitable for APBI. The breast surgeon will mark the tumor bed with clips and if the closure hasn't disrupted or dispersed the clips, APB...
Would you offer neoadjuvant radiation therapy with concurrent chemotherapy for a T4 rectal carcinoma with an associated rectovesical fistula?
In the past, some considered fistulas to be a contraindication for radiation therapy due to concerns about potential worsening. However, our understanding has evolved, particularly in cases where the tumor itself is often the primary cause or a significant contributor to the fistula. Consequently, i...
Would you consider testosterone replacement therapy in a symptomatic, hypogonadal man with a history of prostate cancer?
I would strongly consider TRT in men with a history of treated prostate cancer. If he has undetectable PSA 3 months post treatment, testosterone replacement is likely safe, does not increase risk of recurrence of cancer, will improve sexual symptoms, may improve cardiovascular risk factors, and musc...
How do you apply the concept of a lumpectomy bed boost in the setting of oncoplastic surgery?
This is a very common and often frustrating issue in patients I absolutely feel the need to boost (younger, larger tumors, high grade). I now consistently request my surgeons place a 3D tissue marker (brand name Biozorb) which preserves the location of the lumpectomy despite oncoplastic reconstruct...
How do you approach patients with stage III unresectable, combined histology NSCLC/SCLC?
For stage III lung cancer with mixed NSCLC and small-cell lung cancer, we treat patients with concurrent chemotherapy (cisplatin/etoposide every three weeks) and definitive radiotherapy (60-66 Gy in 30 fractions, QD), followed by adjuvant immunotherapy (durvalumab). The rationales are as follows: Ra...
For a patient with glioblastoma also found to have a distant presumed meningioma with a location/size such that you would have otherwise recommended RT, would you offer concurrent treatment?
I think if the situation is non-urgent and the lesion (meningioma) can be safely monitored, one approach would be to prioritize treatment of the glioblastoma while observing the meningioma. If, however, the meningioma demonstrates interval growth and/or is located in an area at higher risk for causi...
How do you minimize skin toxicity when targeting neck nodes in a patient with HNSCC and skin folds in the neck?
A few technical things in general to avoid grade 3 dermatitis: Mask Fit and Immobilisation • Ensure optimal thermoplastic mask fitting in the lower neck and SCF region at the time of CT simulation. • Minimise air gaps between mask and skin; air gaps impair accurate surface-dose calculation and cause...