Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you consider tertiary grade pattern, LVI or PNI on prostatectomy specimens as adverse features to recommend EBRT and ADT for patients with unfavorable intermediate prostate CA after prostatectomy with undetectable PSA?
No, I don’t think there is any current available evidence to define a benefit for ADT in the post-operative setting for patients with an undetectable PSA. The two major trials which define a benefit for ADT in this setting, RTOG 9601 and GETUG AFU-16 had a lower limit of a PSA of 0.2 at treatment in...
What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?
The value of resection of a high risk small or early stage skin cancer at the medial canthus is potential assurance of complete removal of the skin cancer by confirmation of negative margins. Depending on the extent of disease and surgical approach, this may or may not be straightforward. There are ...
How do you simulate and treat a prostate cancer patient with a persistently full rectum?
Simulation should lead to reproducible and desirable treatment positioning of the patient and their anatomical orientation. For prostate cancer, the state of bladder and rectal filling need to be considered. I think that a "comfortably" full bladder is widely used for simulation and treatment, but r...
What is your approach to adjuvant radiation for anorectal mucosal melanoma s/p wide local excision?
Primary anorectal melanomas are very rare, thus there are no large randomized trials to guide their care. As with any melanoma, surgery is the mainstay treatment. Oncologic surgery often entails APR leading to permanent colostomy thus local excision is sometimes preferred.Following excision, adjuvan...
How do you manage vaginal necrosis after pelvic radiation?
This is a broad topic that doesn't lend itself to a short answer format; however, I will offer a few thoughts. The first thing, of course, is to keep it from happening through judicious RT technique. Vaginal necrosis is most likely due to brachytherapy administration rather than external beam RT, an...
When is radiation indicated in the treatment of perianal paget's disease?
Extramammary Pagets disease is essentially adenocarcinoma in-situ and typically managed surgically. I would not treat with radiation unless it is invasive. If it is invasive and inoperable or if it would require APR, radiation is an excellent option. I treat them like SCCa of the anal canal, except ...
How would you treat a late local recurrence of extramammary Paget's disease of the vulva, not amenable to resection?
If the patient does not have any invasive disease, or underlying malignancy or nodes, then I would consider treating this with radiation, specifically superficial brachytherapy. At our institution, we routinely treat similar patients with large perineal, inguinal EMPD patients with 3D custom printed...
What radiation dose/fractionation would you consider for palliation of an unresectable vulvar cancer that received previous definitive radiation therapy?
For patients with recurrence after definitive vulvar irradiation, surgery is the best option, if possible.If this is not possible, then the retreatment with radiation can only be palliative to reduce pain or bleeding. Depending upon the extent of recurrent disease - a dose of 3000cgy in 10 fractions...
How would you approach a patient with a 12 mm recurrence of the left implant-based breast reconstruction 17 years after her initial diagnosis?
You haven't indicated what prior Rx the patient has received. Assuming no prior RT, I would radiate the chest wall, probably skip the nodes, and add hormonal therapy again, depending on what she has received in the past.
How do you approach reirradiation in a patient who underwent breast-conserving surgery for recurrent breast cancer after initial lumpectomy and APBI?
There is very little data on this scenario, though with increasing numbers of patients opting for partial breast radiation, this will become a more common issue going forward. While mastectomy remains a standard option, many women will desire breast preservation, and we have seen several women treat...