Radiation Oncology   

Have you encountered this scenario? 

Are there other settings where MRI is used for nerve assessment and radiation planning such as for certain definitive RT cases?

Would you hypofractionate or be more conservative at 2 Gy per fraction? Would your management be affected knowing the patient is on hydroxyurea?

Would your management change given that this recurrent lesion is over 10 cm and the patient previously achieved complete response on immunotherapy 5 y...

In which situations or patient populations do you find this useful? How is it sterilized?

If so, what dose-fractionation do you utilize? What other factors do you take into consideration?

Size: 3 cm, cN0

Would you treat the primary site alone, include the hand and arm lymphatics to the epitrochlear nodes (one continious treatment volume from hand to el...

Is T4 disease a contraindication?

Are there any skin care products you would avoid in this population?

I have seen some patients who may undergo large complex closures (sometimes as a separate procedure) for smaller lesions with resulting scars that sig...

Definitive radiation therapy > 5 years ago. Positive margins, PNI of 0.1 mm. What volume would you cover? Dose/fractionation? 

How would you treat the primary tumor (located in the chest)? Would you treat the regional lymph nodes?

If there were negative margins, what other factors would you consider to add adjuvant RT? Size of the tumor or depth of invasion?

Might a prior SJ incident pre-dispose to SJ reaction to radiation? Would you be more or less apt to treat with RT for grade 2 DCIS with refusal of pr...

What agents have you found helpful? What agents have been proven to be effective/non-effective?

In patients with no apparent skin involvement but lymph-node showing basal cell carcinoma with extracapsular extension. Would this warrant radiation o...

Majority of patients on the seminal trial (Gross et al., PMID 36094839) had tumors isolated to head & neck, what was the rationale for this?

Do you base your decision on extent of residual disease?  Does the use of (neo)adjuvant immunotherapy have an impact on surgical site size or he...

Is a placebo-controlled trial anticipated?

If, yes, what dose and fraction size did you use?

If the patient had no nodal sampling, would this influence your decision?

What dose and margins would you use? The patient is s/p a liver transplant on immunosuppression. 

Reference: TROG 05.01 Trial

Groomed facial hair is an increasingly common style for men. Accordingly, there are patients who require treatment of the head and neck who become ups...

Assume a mild but diffuse case of lichens sclerosis with involvement of the ipsilateral breast. If node negative disease, would you recommend she unde...

I have heard of long-term pentoxifylline and Vitamin E daily combination that can prevent and even reverse radiation fibrosis (Delanian et al., PMID 1...

The lesion is still ulcerative despite wound care for two months. Would you treat immediately or wait for healing? Would hyperbaric oxygen to heal ful...

Are there particular indications you use for RT? i.e. multiply recurrent, refractory to other therapies, near critical structures, unresectable (or re...

When tumors come close to chest wall, how do you define skin contour?  

Is there any evidence to support the theory that this may cause worse skin reaction? 

This is an elderly patient with a BCC/SCC over the shin who is not eligible for Mohs due to concern for wound-healing issues. Orthovoltage/superficial...

If so, how long before/after radiation?

Would a history of immunosuppression impact your decision?

Assuming it has previously been treated with excision and steroid injections? Is it reasonable to treat a bothersome keloid in a pediatric patient aft...

What is the role for surgery vs RT?

Would you offer systemic therapy and/or radiation therapy to groin/pelvis? 

If so, how long after phototherapy (eg. NB-UVB) is it safe to proceed with RT? See: Systemic review of phototherapy for pruritic skin disorders

In a patient who would be otherwise fit for surgery +/- adjuvant RT, and the delay is caused by COVID-related OR staffing issues, what would be your a...

Is there any alteration in approach from the medical, surgical, or radiation oncology perspective that can mitigate the risk of forming keloids withou...

What is the role and sequence of surgery and/or RT? Which nodal levels would you include in your RT field(s)?

What approaches (surgical vs non-surgical) offer the best cosmesis for keratoacanthoma (low grade squamous cell carcinoma) ? 

Is there a role for radiation? Does your approach differ depending on site(s) of  disease, and/or if the patient has Basal-Cell Nevus (Gorlin) sy...

In general, how would you approach such a case with regards to creation of your treatment volumes and dose-fractionation? 

Would you recommend radiation therapy or immunotherapy? If proceeding with radiation therapy, what dose-fractionation and technique would you utilize?

What dose-fractionation schedule would you utilize?

When do you electively treat the ipsilateral versus ipsi- and contralateral neck?

This particular case involves a patient with a frontal scalp low grade eccrine carcinoma status-post excision with positive margin complicated by...

Would you recommend locoregional radiation therapy or systemic or immunotherapy alone? If you would consider radiation therapy, what would be your rec...

If this upstages the patient, do you modify treatment recommendations?

Given the location but no other high risk features would you offer RT?  If so, what dose and fields? 

What pathologic features are most important when evaluating the possible need for adjuvant therapy?

Would you offer RT? If so, shat dose fractionation do you recommend? 

*Negative margins, <1cm in size, no LVI, negative SLNB, not immunocompromised, no prior surgery (as well as a negative PET/CT scan).

If so, what is your suggested dose/fractionation? 

NCCN lists only substantial perineural invasion.  What about other high-risk adverse features such as histologic subtype, multiple recurrences, d...

When elective nodal radiation is recommended, which nodes would you treat (i.e. facial, pre-auricular, peri-parotid, levels I-III, etc.)?

Patient underwent a shave biopsy of a 6x5x2mm preauricular lesion that showed moderatley differentiated sebaceous carcinoma with deep and lateral marg...

What dose/fractionation would yield the lowest risk of graft failure? Does your treatment management change based of location, ex the ear vs back?

If so, how large of a margin would you place on the primary lesion and would you incorporate any adjacent lymph node levels?

Following Mohs surgery and in the absence of other high risk features, do you offer RT for any PNI?  A single nerve < 0.1 mm? A single ne...

Would re-irradiation be an appropriate option? What dose/field would you incorporate? If treating with standard fractionation, would you take the enti...

If so, what is your treatment volume?

Is modern surgical/reconstruction treatment superior to radiation therapy? If contact brachytherapy or superficial (orthovoltage) therapy isnt possib...