Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is it appropriate to use SBRT on unresectable pancreatic tumors invading the duodenum?
Duodenal invasion would be considered an absolute contraindication to SBRT at our institution. If you look at the early SBRT experiences, such as the Danish phase II trial (PMID 15990186) which treated with larger margins than we use today and did not pay as close attention to the duodenal dose, the...
Given the results of PLATO anal cancer study, is 4140 cGy the new standard for early stage anal cancer?
The original Nigro regimen using 30 Gy was effective for anal cancer treatment, and so it is not surprising that 41.4 Gy for early stage anal cancer is similarly effective. The Lancet publication is a pre-planned secondary endpoint of cCR, and not the primary endpoint of the trial which is 3-year lo...
In the post-mastectomy setting, are there situations where only the regional nodes or targeted nodal basis are covered?
Thanks for asking this question. People occasionally ask this. Essentially all of the trials that show a survival advantage with PMRT used comprehensive local-regional therapy. So, doing something other than both the chest wall and nodes would not be based on the available data. Cancer is sneaky, i...
What is the optimal/safest regimen for re-irradiation of a partial chest wall following surgical resection of an isolated chest wall recurrence?
I agree with Ben that this is a difficult scenario. Resection with new tissue is ideal, but cannot always be done. Removal of the gross disease with some type of resection is also optimal if possible. Use of chemotherapy for isolated chest wall recurrence is controversial, but is often done. I pers...
In light of the NSABP B-51 data presented at SABCS, will you defer RNI in all patients with negative nodes after chemotherapy?
Results of the NSABP B-51 trial were presented at the 2023 San Antonio Breast Cancer Symposium (Mamounas et al., abstract GS-02-07). This trial was designed to test the value of postoperative radiation therapy in patients who presented with clinical T1-3N1 tumors with biopsy-proven axillary node inv...
How do you treat a large basal cell carcinoma involving the dorsum and entire tip of the nose when brachytherapy and orthovoltage are not feasible?
Hard to know without seeing, but likely create 3D bolus and treat with electrons. Can also potentially do IMRT/VMAT with photons, likely more homogeneous dose distribution, but I typically favor electrons just based on comfort.
Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?
For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.
Does an esophageal stent impact your radiation treatment plan for a patient with non-metastatic GE junction adenocarcinoma?
While the presence of a stent might not directly affect my radiation dose and volumes, due to numerous other considerations, it would certainly affect my overall treatment plan. I highly encourage avoiding a stent in the setting of radiation due to toxicity concerns in addition to the complications ...
What radiation treatment volume would you include in chemoradiation given for perihilar lymph node recurrence after surgical resection and mediastinal lymph node dissection for NSCLC?
I typically ask for a PET-CT, MRI brain, and comprehensive EBUS. If isolated to the hilar LN, I would just cover that region and not any elective nodes.
Would involved site radiation therapy be recommended in a patient with POEMS syndrome whose myelopathy symptoms worsened after one cycle of CyBorD?
I would swiftly treat this patient with a common schedule, for instance, 5 x 4 Gy. I do not see any risk of concurrent rituximab.