Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach post-op radiation recommendations in patient who had neoadjuvant chemotherapy for locally advanced oral cavity cancers (oral tongue) who have a complete pathologic response (pCR) after surgical resection?
While randomized studies of induction chemo followed by local therapy compared with local therapy alone in the 90’s were all negative, it was clear that responding patients did better than non-responding ones. An example is a study (Licitra et al., PMID 12525526) of quite advanced oral ca randomized...
How long after resection for brain metastasis do you wait to request a radiation planning MRI?
This is a good question, and I agree with the sentiments above. I think there are two competing issues here--1) evolution of the cavity and 2) regrowth of microscopic disease.While intuitively, one might think that waiting longer might allow the brain to normalize and the cavity to shrink, our data ...
How do you approach the treatment of LS-SCLC after SBRT for a prior NSCLC in the ipsilateral lung?
You know, it was so rare to see this in the first half of my career, and now I see it a few times a year. It's a testament to the improvements we are seeing in the care of lung cancer patients... they are getting 2nd cancers. Where I am (Mayo), we generally treat it exactly like an SCLC from the per...
Is there a role for quad-shot or similar regimen in a patient with a technically resectable, but medically inoperable colon cancer that is both bleeding and causing a partial obstruction?
I do not use quad shot for the palliation of gastrointestinal tumors. I do not believe in giving doses larger than 3 Gy per fraction because it uses up tolerance, and it's difficult to retreat. My strategy is to be able to treat the patient again after recovery of tolerance in a year. This usually r...
Is keratosis follicularis (Darier disease) a contraindication to the receipt of PMRT?
Thanks for this interesting question. It prompted me to do a bit of literature search and think about how I'd approach this case.For a postmenopausal patient with ER-negative, PR-negative, HER2-negative (triple-negative) pT2N0(sn) breast cancer and unresectable positive surgical margins after mastec...
What is an acceptable maximum "bridging" dose between SRS/SRT targeted brain metastases in close proximity to one another?
Hi @Dr. First Last, hello from your neighbor in Flint, I hope this helps: I use "Brain Minus GTV" as my normal brain OAR, and to reduce the risk of radiation necrosis/edema, I try to keep it under: V12 at 5 cc or less for single fraction SRS; above that I will fractionate V28.8 at 7 cc or less when ...
Are there patient populations in whom you would consider using both induction chemotherapy and maintenance pembrolizumab for a patient with locally advanced cervical cancer?
Would consider for patients with multiple pelvic and high pa bulky nodes where risk of distant mets is extremely high, with the goal to treat with systemic intent, and if good response and no mets, proceed to definitive chemo-RT.
In patients with concomitantly diagnosed stage IV DLBCL and gastric MALT lymphoma who have residual gastric MALT after 6 cycles of Pola-R-CHP, would you alter the standard dose/fractionation for ISRT for the gastric MALT lymphoma?
Chemoimmunotherapy, while potentially curable for aggressive non-Hodgkin lymphomas such as DLBCL, is not generally considered a curative treatment for low-grade histologies, such as follicular and marginal zone lymphoma. After completing appropriate therapy for the more aggressive histology (DLBCL),...
What radiation fields would you recommend in a young patient with luminal B histology and ITCs in a single sentinel node?
I would not change the RT field, which could be APBI or whole breast, based on technical and biological factors (presuming this is upfront ITC).
How do you manage chronic radiation laryngeal edema for patients treated with RT for a larynx primary in the past?
I agree with @Dr. First Last's response above. I think it is important to differentiate between laryngeal edema resulting from RT and persisting as a sub-acute toxicity, as opposed to a patient who was treated in the past for larynx cancer and then develops laryngeal edema unexpectedly. In the forme...