Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a recurrent meningioma of the cervical spine after resection alone?
I had a case like this 2 years ago. Treating with 5 fractions felt so "en vogue" and I therefore phoned some CNS-focused friends who may be considered spine SBRT leaders, and they all recommended standard fractionation, supporting my inclination.My case was a subtotally resected Gr 1 tumor with blan...
Given the favorable data for the FAST and FAST-Forward trials, can we consider those ultra-hypofractionated whole breast radiation schemes to be standard of care for early-stage breast cancer?
With respect to FAST (28.5 Gy in 5 fx over 5 weeks), it can be considered based on 10-year data. Local control rates were low in all arms, but in general, I limit this to patients who can't do standard hypofractionated WBI (40/15).FAST-Forward now has 10-year outcomes and can be considered for appro...
What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?
The incidence and the timeframe of the development of radiation myelopathy are influenced by total radiation dose, radiation dose per fraction, time between courses of radiation, and associated chemotherapy or immunotherapy. Older age, the presence of diabetes, and previous exposure to radiation are...
What is your first line strategy in managing acute esophagitis during thoracic RT?
Zombie Question (dead thread reanimated by theMednet)!!! The amount of esophagitis that I see in practice has really diminished over the course of my long, graying career. If you ever wanted to see a horrific esophagitis, treat a Turrisi regimen to those volumes. 60% of patients got Grade 2+ esophag...
What is your approach to pancreatic adenocarcinoma s/p surgery with N0/R0 disease and intermediate risk factors with regard to adjuvant chemo-radiation?
With the presentation of RTOG 0848 at ASCO 2024, our practice has changed to offer adjuvant chemoradiation if there is no evidence of distant spread after the completion of any planned adjuvant chemotherapy. Per 0848, we are only offering radiation to patients with tumor of the pancreatic head (body...
Would you offer radiation for a plasmacytoma found on piecemeal endoscopic resection of an initially presumed nasal polyp if subsequent PET/CT was negative and no surgical margin status was known?
In general, unless an oncologic procedure was performed to address a solitary plasmacytoma, I would recommend a course of RT. For a lesion removed piecemeal, the risk of residual microscopic disease is quite high. As the lesion was small and only microscopic disease (presumably) remains, given the n...
Would you offer adjuvant radiation in a woman with solitary plasmacytoma of the breast who underwent lumpectomy with clear surgical margins?
Postoperative radiotherapy for extraosseous solitary plasmacytoma is often offered, since many of these tumors arise in areas where wide surgical margins cannot be obtained and the risk of recurrence is high, one common scenario (as far as one can call extraosseous plasmacytomas "common“) are tumors...
How would you treat a patient with HER2 positive CNS only progression on fam-trastuzumab which had previously progressed on tucatinib/capecitabine/trastuzumab, and has failed both SRS and WBRT?
I would present or refer her case to a multidisciplinary tumor board to 1) review her MRI to confirm there is progression vs. therapy changes, 2) see if she is a candidate for resection or irradiation of the progressing lesion (possibly using bevacizumab to reduce risk of radiation necrosis), and 3)...
How do you manage early stage uterine carcinosarcoma?
Unfortunately, no good prospective study has shown an impact on survival with any adjuvant treatment. Based on relapse patterns at our institution for surgically staged IA disease, it is chemotherapy (ifosfamide plus taxol) plus cuff brachy. For all other stages, it is usually chemo as above followe...
What is your approach when it comes to reirradiation for DIPG patients who have already received 54Gy upfront?
Early case series reports from MD Anderson suggested that focal re-irradiation (re-RT) for progressive DIPG after full course primary RT was fairly well tolerated, resulted in symptomatic improvement in the majority of patients and was associated with the most durable, albeit temporary, tumor contro...