Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is it necessary to cover the drain sites during post-mastectomy radiation?
I have not been chasing/treating the drain site for PMRT unless it is in a conventional chest wall field. The recurrence data does not suggest that the drain site at risk after PMRT. Below is review of site of relapse after mastectomyhttps://www.ncbi.nlm.nih.gov/pubmed/26383675
Would you give adjuvant radiation after complete resection of a small primary cutaneous follicular lymphoma of the scalp?
Not a lot of data, but here goes. First, one has to go back decades in the literature to find series of patients with lymphoma rx'd with surgical resection alone. In general addition of RT improved outcome even when ostensibly resected with neg margins. With today's technology risk of additional RT ...
What would be your radiotherapy plan for a patient with recurrent GBM (WHO grade 4, IDH wild-type) s/p 2 prior resections with no prior radiation?
The scenario described in this clinical case is not uncommon. I have had patients who either live several hours away from our center or were unwilling to receive the Stupp protocol of 60 Gy in 6 weeks and were successfully treated with 3 weeks of hypofractionated RT (HFRT). HFRT over 1–3 weeks (25 G...
When using concurrent hyperthermia with reirradiation, is there any benefit to delivering hyperthermia on non-RT days?
Hyperthermia alone, in the absence of radiation or chemotherapy, is not effective as cancer therapy, notwithstanding occasional reports to the contrary from sources of questionable reliability. Hyperthermia is a very effective sensitizer for both RT and chemo. Note that we are not. discussing high-t...
Do you still recommend protons for grade 2 and grade 3 glioma, following the Soprano study results showing a survival detriment?
I should start by saying that I generally do not recommend proton therapy for grade 2-3 gliomas in adults unless there is a clear and specific indication. Modern photon techniques such as VMAT are highly conformal, efficient, and safe, and they form the backbone of the evidence base that guides our ...
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
A network of specialists familiar with cSCC is necessary to optimize care that is tailored and appropriate for each unique case. Avoiding under-treatment and over-treatment is important, but also challenging, given the high volume of cSCC tumors with variable patterns of presentation and numerous cr...
For a patient s/p laryngectomy with positive margins, would you start radiotherapy 6 weeks s/p surgery if there is a delay in concurrent chemotherapy?
The question is a bit challenging without understanding the reason why the patient is suited for XRT but not chemo. My best guesses would be a concurrent infection or PS issues, possibly due to deconditioning after a hard surgery.However, part of the decision would involve when it is anticipated tha...
Under what circumstances would you offer adjuvant RT following breast-conserving surgery for borderline phyllodes tumors?
There is no definitive data, with some suggestion: all with borderline and malignant phylloides after BCT should be considered for RT (Dartmouth single arm study). In our practice, we offer for margin less than a cm, or if tumor is 5 cm and above after breast conserving surgery.
What GTV to CTV expansion do you utilize for NPC?
Many have moved in that direction. I believe MSKCC has been doing this for years for HNC. I believe with good imaging/fusion (including MRI), doing direct GTV to PTV (3-5 mm expansion, dependent on imaging protocol) is reasonable and likely less toxic. I do this for most head and neck patients if th...
How would you treat a sebaceous carcinoma of the orbit definitively with radiation, if they refuse exenteration?
I would stress that RT would destroy the eye. 70 Gy at 2 Gy per once daily fraction and electively irradiate the regional nodes. Would prefer SIB. No chemo.