Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you start steroids for radiation pneumonitis?
Great question on a relevant clinical topic. It's very important to remember that pneumonitis is a diagnosis of exclusion. Sometimes, if the timing is right and the patient's presentation is typical, there is a tendency to move quickly to the conclusion that the symptoms are caused by pneumonitis. R...
If a patient has a history of lumpectomy and adjuvant radiation, and then develops an in-breast recurrence s/p mastectomy with breast only disease and no nodal disease, would you re-irradiate the chest wall?
Typically not. Now, if the breast lesion is very large or has a positive margin, or was stuck to the muscle, I would consider re-RT. In the adjuvant setting, PMRT is beneficial, but the therapeutic ratio is not that large. Remember some of the older studies (and studies w/o chemotherapy) did not dem...
Would you consider once weekly radiation with a simultaneous integrated boost for a patient with node negative breast cancer with a positive margin for whom reexcision is not an option?
If the patient is advised on data and risk, it's not unreasonable. Another alternative is once weekly whole breast and then add a 6th-week boost.
What would your approach be for a locally advanced head and neck cancer diagnosed concurrently with a mid-esophageal cancer?
In the handful of similar cases that I have seen, I have worked with medical oncology to tease out a concurrent chemotherapy regimen. What we have often ended up doing is treating the head and neck cancer as normal (to 70 Gy) and the esophagus cancer to a relatively standard dose (usually to 50 Gy t...
How do you manage/treat acute radiation-induced enteritis?
I have no problem with the excellent comments already made. However, I think it is important to add some comments. First - one needs to be sure that the patient truly has radiation enteritis. Many patients receiving abdominal radiation therapy have other issues that need to be explored first. For ex...
Do you consider NSCLC with multistation N2 involvement appropriate for treatment with neoadjuvant chemoimmunotherapy followed by surgery?
Interesting question and something that is frequently discussed in tumor boards. Multistation N2 patients were not included in neoadjuvant trials and hence, any adaptation of this strategy to patients with advanced N staging would not be appropriate at this time. Further, given level 1 evidence from...
How would you treat bilateral groin recurrence of vulvar small cell neuroendocrine carcinoma in a patient who has previously had pelvic and groin radiation?
I would start with chemo-immunotherapy, like in pulmonary small cell, as this is likely to be the tip of the iceberg. If no prior groin surgical exploration, this can be considered by gyn/onc. If not, I would consider focal reirradiation of any residual disease after chemotherapy during IO maintenan...
Is there a scenario in which you would consider observation for T4a SCC involving the mandible?
While PORT is well established, the scientific basis for it is relatively weak in the absence of a randomized trial, as all phase 3 trials have focused on adding something to radiation rather than the benefit of radiation alone. Further, the rationale for PORT historically is if there is a belief of...
What is the preferred neoadjuvant/adjuvant chemotherapy regimen for HPV-associated nasopharyngeal cancer?
Let me give more context: Had an interesting conversation with a med onc colleague regarding neoadjuvant or adjuvant gem/cis for HPV-associated NPC. I personally make a distinction between EBV-associated NPC and HPV-associated NPC. My interpretation of the data is that the benefit is only/mainly for...
For unresectable-appearing BRAF V600E papillary thyroid cancer involving the trachea and carotid artery, is neoadjuvant targeted therapy a viable path to surgery, or is definitive radiation the better option?
If the tumor is considered unresectable due to carotid encasement, as is likely in this case, then neoadjuvant targeted therapies should not be considered. Multikinase inhibitors (i.e., lenvatinib) or targeted therapies (dabrafenib and trametinib) will not produce great enough responses to make the ...