Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you sequence adjuvant chemo-immunotherapy (paclitaxel/carbo/pembro or paclitaxel/carbo/dostarlimab) with EBRT and vaginal cuff brachytherapy in advanced uterine cancer that meets clinical criteria for both EBRT and chemo-IO?
A common misapplication of RUBY/GY018 is giving IO in patients with non-measurable advanced uterine cancer. Radiation as part of the trial was not included in these studies. The role for chemo-IO vs chemo alone (with or without radiation) for high risk non-measurable uterine cancer was tested in GOG...
Given the results of KEYNOTE-A18, do you plan to recommend adding pembrolizumab to primary chemoradiotherapy for advanced stage cervical cancer?
Until the paper gets published, we won't really know a lot of details that may influence the potential utility of this regimen. It has an abstract/presentation and has recently received FDA approval.It is a relatively 'newer' idea in improving outcomes that we as an institution are open to start off...
How are you using the Decipher score in the definitive setting for prostate cancer?
This is an excellent question.Before I can answer the question directly, you must ask yourself how do you currently decide who to give ADT to with RT?The easy answer is that you use RCTs to choose who to give short-term and long-term ADT to. However, I wish it was that easy.Lets take RTOG 9408- It i...
How do you manage early stage I uterine serous carcinoma?
The management of these patients remains controversial. The data are conflicting and treatment choices tend to be based more on impressions than solid data. Most clinicians advocate chemotherapy although randomized trials have not clearly shown benefit for this subset. For stage IA, we typically tre...
Would you consider radiation omission for a patient with a Stage I breast cancer with an elevated Oncotype Dx?
I would offer the patient treatment based on the fact that she is in her 60s with a presumably long life expectancy, a high grade lesion, and radiation will lower her risk of local recurrence significantly. Even with a lower Oncotype, radiation will lower the risk of recurrence significantly accordi...
If a patient has distal esophageal adenocarcinoma and a PET+ left supraclavicular lymph node, and nothing in between, would you cover the entire esophagus? Both supraclavicular fields?
My experience is anecdotal. I have often seen nodal spread from the paraaortic or GEJ nodes skip to the supraclavicular nodes with nothing in between. Since treatment of the entire esophagus would not be tolerated by most patients, I have elected to treat standard volumes and the involved SC nodal s...
Is REZUM (water vapor thermotherapy for BPH) safe after EBRT?
Although I am not aware of any studies evaluating the toxicity rates in patients undergoing REZUM after RT, I am aware of a few studies reporting the toxicity of TURP after RT. For example, Liu and colleagues conducted a retrospective review of the outcomes of 1,192 patients, 246 of whom underwent a...
How would you manage a large area of multiple, recurrent cutaneous squamous cell carcinomas of the scalp with ulcerations and non-healing areas despite cryotherapy, multiple Mohs procedures, and 5-FU?
Consider sending the patient to medical oncology for evaluation for cemiplimab. Large areas of the scalp can also be treated by making a 1 cm "cap" of bolus and utilizing VMAT to cover scalp soft tissues, with elective coverage of nodes and perineural pathways if indicated.
How have the results of the phase III RTOG 0631 trial impacted your use of spine SBRT?
NRG/RTOG and the investigators are commendable for completing this important trial and reporting the outcomes. The possible reasons for the negative results of the SBRT arm were discussed in the plenary session at ASTRO 2019 and in the Discussion section of the JAMA Oncol paper by the authors. This ...
Is Rad51D heterozygous mutation a contraindication to postmastectomy radiation?
BRCA1/2, PALPB2, CHEK2, and RAD50/51 mutations should not affect radiation therapy https://www.redjournal.org/article/S0360-3016(19)33530-8/fulltext