Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for bevacizimab (IV or IA) for steroid refractory radionecrosis for AVM?
Radiation necrosis (RN) following SRS can occur at variable intervals of time following treatment, usually occurring 9-18 months later. The preferred first line of approach is usually steroids, as done in this case. I usually look at the MRI-Flair images and determine the dose of dexamethasone depen...
Is there a role for definitive radiotherapy in patients with de-novo metastatic cervical cancer after achieving complete response with chemo-immunotherapy per KEYNOTE-826?
We don't know the true impact of local treatment or the durability of CR from chemo IO response. In situations like this, I have sometimes done brachy alone to treat the primary site for local control and prevent future symptomatology.
How would you approach a patient with plasmablastic lymphoma of the nasal cavity s/p excisional biopsy to positive margins who is not a candidate for systemic therapy?
Plasmablastic lymphoma is a particularly aggressive non-Hodgkin lymphoma. It commonly arises in the H&N region, often in patients who are immunosuppressed for one reason or another. Most patients present with advanced disease.For patients with stage I-II disease, a combined modality therapy approach...
What volumes do you treat for ISRT for extranodal DLBCL?
It is important to remember that ISRT, for both Hodgkin and non-Hodgkin lymphoma, consists of a set of principles that can be used to design rational radiation fields in the context of modern treatment planning. In general, only sites of original involvement are treated when patients also receive, a...
When utilizing ISRT for Hodgkin lymphoma, what volumetric expansions (ITV and PTV) are appropriate on top of the CTV that includes the original pre-systemic therapy disease?
First, it is important to realize that involved-site radiation therapy (ISRT) for Hodgkin lymphoma is not a formulaic approach to field design. It requires careful evaluation of pre-chemotherapy imaging, fusing these with post-chemotherapy planning CT scans for optimal target delineation, evaluating...
How do you approach radiotherapy planning when there is no identifiable prostate tissue after HIFU or TURP?
I am not sure why there would be no identifiable prostate tissue. There was apparently enough to detect cancer on biopsy, which is ultrasound-guided, so someone must have seen prostate tissue at that time. I suggest getting a high-quality MRI and a careful review. I would also order a PSMA PET for r...
Is it reasonable to use hypofractionation in early stage male breast cancer s/p lumpectomy?
Absolutely the same as what we do for women with breast cancer.
How do you approach dosing for post-op HNSCC nodal regions with ECE?
This is an area in which the communication between surgeon, pathologist, radiologist, and radiation oncologist is particularly helpful. While our surgeons try to submit nodes with descriptive identification of the nodal level they arise from, it still occasionally happens that we see a pathology rep...
How would you manage eccrine porocarcinoma of the great toe with positive superficial groin and pelvic lymph nodes s/p toe amputation and pelvic lymph node dissection?
Eccrine porocarcinoma (EPC) is an aggressive but rare skin malignancy, let alone one occurring at the great toe! A meta-analysis (Salih et al., PMID 28721214) of worldwide reports on EPC prior to 2016 offered a good overview of the disease’s natural history. It was noted that 31% had metastasis upon...
Is stage N2a alone an indication for PORT in oropharyngeal squamous cell carcinoma with no other adverse features?
The short answer is yes, based on it falling in a list of indications for post-op xrt, which includes lymph node size > 3cm. Further, if this were an oral cavity tumor, some would argue that any node positive patient should be treated adjuvantly (ie even N1, though interestingly many oral cavity can...