Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient who developed an intraprostatic abscess after SpaceOAR injection, prior to starting radiation?
Rectal spacer complications are rare, but still happen. In a recent review, 0.4% of patients experienced a complication resulting in an adverse event report. 13% of these reports had a CTCAE of >= 3. Some of these adverse event reports (91/981) were abscesses related to SpaceOAR placement (Millot et...
How do you manage the thickened secretions secondary to xerostomia during head and neck radiation?
I find that the management of acute effects of RT for H&N treatment is somewhat of a dark art. What works for one patient may not work for another. The thickened secretions are from acute irritation of the salivary glands and not so much from "xerostomia" during the acute phase of RT. For thickened ...
In a patient with metastatic breast cancer who has progressed on multiple medications and has now developed multiple brain metastases, what is your radiotherapy plan if the patient is taking sacituzumab govitecan?
The limited published data have not shown increased complications with SRS along with sacituzumab, unlike increased necrosis seen with HER2/neu antibody conjugate. Khatri et al., PMID 41026418
How would you alter your treatment volumes in a patient with distal esophageal cancer who has had prior gastric bypass surgery?
Some additional context would help in answering this question. For example, is this patient a surgical candidate and is the intent of radiation as part of preoperative treatment, or is this definitive therapy in an unresectable patient? Also, what is the concern that is leading to the question? Is i...
In a patient treated with peri-operative chemotherapy via the MAGIC regimen for gastric cancer who has a locoregional relapse in unresectable celiac node, how would you approach radiation treatment?
I would give an ablative dose to the node. These nodes are usually not near GI structures. I would electively treat the PA, portal, and splenic artery nodes with a microscopic dose at least down to the level of the IMA. I would not electively treat the remnant in the salvage setting. Dose options d...
How would you treat a stage I peripheral <3cm extranodal marginal zone lymphoma of the lung? Is SBRT appropriate? If so, what dose would you use?
Marginal zone lymphoma of the lung is a very uncommon variant of MZL but appears to have the same favorable outlook as MZL in other locations. Standard dose for localized MZL is 24-30 gy (2gy per fraction) with lower doses generally used in the eye with local control exceeding 90%. Investigations ar...
Under what circumstances do you consider an enbloc resection versus biopsy for a lower lumbar spinal column tumor?
Typically, a biopsy is performed prior to en bloc resection rather than “either or.” A biopsy is necessary if there is a differential diagnosis based on imaging, and if the diagnosis will affect management: radiation and chemotherapy alone vs. intralesional resection/debulking and adjuvant therapy v...
What dose constraints do you use for 15-25 fraction hypofractionated RT for cholangiocarcinoma?
5Fx 10fx 15fx 25fx Ablative dose 50Gy 60Gy 67.5Gy 75Gy GI tract pt dose (0.2cc) 30Gy 40Gy 45Gy 60Gy Bile Duct pt dose (0.2cc) 40Gy 65Gy 70Gy 80Gy Liver – GTV Mean dose + 700cc below + 1/3 liver over 15Gy 20Gy 24Gy 28Gy Mean dose CP...
Do you obtain MRI for cutaneous SCC with microscopic PNI to assess for gross perineural tumor spread?
I would recommend both an MRI as well as consulting the pathologist regarding the exact nature of the PNI. We had an experience with more than 100 patients (Sapir et al., PMID 27475277). Those with gross PNI (evidenced by MRI, with or without cranial nerve deficit) and microscopic extensive PNI (>2 ...
How would you manage a patient with recurrent, high-grade leiomyosarcoma involving the pelvis after salvage exenteration, but who has a focally positive anterior margin?
Ideally, plan for intraoperative radiation or surface brachytherapy at time of surgery.