Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does the presence of LCIS on pathology in a patient with IDC impact your decision to offer APBI?
It doesn’t change the decisions for APBI with all other factors being favorable. We offer APBI to invasive lobular also if it meets all criteria and had MRI breast done as part of the evaluation.
How would you manage a solitary, painful, lytic bony lesion in a patient with negative PET/CT but bone marrow biopsy confirmation of multiple myeloma?
This is a palliative scenario, but the approach may differ based on the clinical circumstances. If Heme Onc is planning on administering systemic therapy, then a short course of palliative RT to expedite pain control would be appropriate. Treatment of many sites (e.g., femur) can be done very quickl...
What, if any, radiation regimen would you use for knee arthrofibrosis in a patient undergoing repeat arthroscopy with lysis of adhesions?
The high-dose single fraction regimens seem to be adapted from heterotopic ossification protocols and would be my choice if there was a concern for HO. If the concern is for the reaccumulation of fibrotic tissue, I favor LDRT such as 0.5 Gy 2-3 doses weekly for 6-8 fractions. There will be more sust...
Do you typically recommend avoiding neupogen during radiation treatments?
It depends on the reason and expected benefit. If myelosuppression is holding up RT for cervical cancer patients, then I would not hesitate to give neupogen to avoid or minimize a treatment break. There would be more benefit to neupogen and continuing RT than a downside. Usually, I would try to give...
When would you consider initial induction chemotherapy (e.g. FOLFOX) followed by neoadjuvant chemoradiation, over neoadjuvant chemoradiation alone, in patients with locally advanced rectal cancer?
At MSKCC, we now routinely recommend induction chemotherapy (8 cycles of FOLFOX) to any rectal cancer patient who requires preoperative chemoRT. Initially, we adopted this approach for patients with particularly bulky or node-positive disease (as per @Dr. First Last's answer above) but now do it for...
For marginal recurrences of skin cancers after prior hypofractionated radiation therapy (i.e., 30 Gy/5 fx, 55 Gy/20 fx) where there is concern for overlapping fields, could reirradiation with a hypofractionated course be considered?
For a marginal recurrence of a cutaneous malignancy after definitive hypofractionated RT, I would not necessarily offer reirradiation. I would have my plastic/dermatologic surgeon see the patient for consideration of surgical salvage, which may likely require an advanced reconstruction. If the patie...
Do you boost a breast cavity for a high Ki-67 index in the absence of other risk factors?
Ki-67 has some level of subjectivity with inter-individual variation. If genomic testing, like Oncotype or Mammaprint, has been done, I would favor using that to decide whether the patient is low risk or not over k1-67 alone.
Would you offer PMRT to a patient with potential metastatic disease?
If an additional ER scan is planned, I will wait to see the results. If there are unequivocal mets, I would not offer PMRT; otherwise, I would offer PMRT. If PMRT is offered, I will start endocrine therapy, but add the CDK4/6 inhibitor after RT is done.
How do you counsel patients about prognosis with FIGO 2018 IIIC cervix cancer managed in the new era of chemoradiation plus immunotherapy?
The prognosis is still a function of nodal location, number of nodes, local T stage, histology, and response to the EBRT portion of treatment. The local control is closer to 90% with a predominant pattern of failure being distant (around 20-25%). Also based on A-18, 3 years PFS is around 70% and OS ...
How would you manage new symptomatic brain metastases (10-15) in a young woman with HER2+ metastatic breast cancer?
A lot of nuance to answering this on a per-patient basis.First question, how symptomatic? (As in, are there bulky mets that we should be considering surgical management upfront plus this also guides my discussion about whole brain vs systemic)If not acutely symptomatic and requiring a crani/resectio...