Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat single celiac focus of adenocarcinoma of unknown primary?
Given the high rates of local control and favorable toxic effect profiles of SBRT, I will treat it with SBRT. Some retrospective research studies and small phase 2 randomized clinical trials have reported overall survival or progression-free survival benefits specific to localized metastatic tumor a...
Would you offer reirradiation for a patient who had prior MammoSite PBI?
Based on the effect of the previous RT, I have treated and favored 40 in 15 whole breast.
How do you manage the chemotherapy portion of chemoradiation in a patient with stage IIIB (hydronephrosis) cervical cancer, on hemodialysis?
I will make sure to discuss with the patient's nephrologist to see if there are any special considerations, but in general, it is safe to consider either carboplatin or cisplatin with appropriate dose medications while on hemodialysis. In managing these patients, I have found most nephrologists pref...
Do young, early-stage breast cancer patients with pCR to chemoimmunotherapy still benefit from PMRT?
As far as I am aware, it is not part of the usual practice to offer PMRT in the setting of T2N0 TN breast cancer. Though I think it may be considered as an "out of the box" recommendation in the setting of multiple high-risk features (larger T2 size, poor response to neo-adjuvant tx, LVI, young age,...
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 ...
How would you approach a T1N1 NSCLC with a small peripheral primary tumor and single hilar node in a patient not fit for concurrent chemo or surgery?
If the patient were not a candidate for surgery or chemotherapy, then I would favor hypofractionated radiotherapy to 60 Gy in 15 fractions to both the primary and the hilar lymph node based on UTSW phase I data. If the patient may be a candidate for immunotherapy, then I would strongly consider enro...
For a young patient with high grade pT1N0 medially located breast cancer, under what circumstances would you include the IMN in your treatment fields?
For patients treated with upfront surgery who are T1N0, I personally do not radiate the lymph nodes, even in young patients with high grade lesions. An exception could be in patients with extensive LVI where the likelihood of nodal involvement is higher. For patients with initially more advanced dis...
Would you treat a pleomorphic sarcoma of the pelvis post-operatively?
This is a difficult question to answer directly because it depends very much on the precise anatomic location of the tumor and the extent of surgery. A pleomorphic sarcoma in the pelvis could represent: Lower retroperitoneal pleomorphic sarcoma (which can include the pelvis) Arising from the pelvic...
What is your preferred dose/fractionation for WHO grade 1 meningiomas?
This question includes many offshoots which impact optimal dose and fractionation, such as target volume, anatomic locale, presence of edema, surgery and its extent, and recurrence status. Patients with small (<10 cc, perhaps even <7.5 cc) supposed (unresected) WHO grade 1 meningioma do very well wi...
How do you manage a cervical cancer patient on anti-coagulation for pulmonary embolism requiring interstitial brachytherapy boost?
Have done with IVC filter and switch to heparin days prior to the procedure so that can hold anti coagulant for the procedure and epidural placement for analgesia.