Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
What is the optimal treatment for a locally advanced rectal cancer on the anterior wall abutting the prostate in a medically inoperable patient with a remote history of LDR brachytherapy for low risk prostate cancer?
I would start with chemotherapy if that is an option and tailor RT dose to some extent based on response. If there is great response even local excision can be evaluated? Rectal and urethral complications are high and I have seen patients developing these complications even with 45 to 50.4 Gy preop ...
Would you offer lung SBRT in a patient with Pulmonary Langerhans Cell Histiocytosis (PLCH)?
Langerhans cell histiocytosis (LCH) is a clonal proliferation of Langerhans cells (dendritic cells), part of the mononuclear-phagocytic system. Some patients present with unifocal disease, often in bone. A variety of treatments are acceptable for unifocal disease, including radiation therapy. Very l...
Which imaging modalities and schedule do you use to follow stage I-II follicular lymphoma that was treated with radiotherapy alone?
PET has been demonstrated to be more sensitive and specific in staging for FL as well as a strong independent predictor of outcome after treatment. Patients also have ~50% risk of developing recurrence outside the RT volume - and PET allows for whole-body imaging. PET is therefore the imaging modali...
Does the presence of interstitial lung disease (excluding IPF) affect your decision to offer conventional fractionated RT for Stage III NSCLC?
Tough question. I think a key step would be how certain the diagnosis of ILD is. I.e., was this a comment incidentally on a CT scan from radiology, or does the patient have active ILD management by a pulmonologist? Certainly, UIP patients appear to have higher rates of severe toxicity following RT. ...
How do you decide timing of adjuvant radiation with respect to chemotherapy for a patient with resected pancreatic adenocarcinoma with microscopic positive margins?
Level 1 evidence supports chemotherapy, FOLFIRINOX is the standard. The benefit of radiation is modest in comparison and based on post-hoc analysis of phase III trials (ESPAC-1, and others that are themselves nearly uninterpretable). The answer to this question is chemotherapy followed by restaging ...