Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for induction chemotherapy for locally advanced head and neck squamous cell carcinoma prior to definitive chemoradiation?
Induction chemotherapy can be considered in some patients with locally advanced SCCHN, primarily those patients with large bulky tumors who are at highest risk for developing distant metastases. Moreover, if you are looking to attain reduction in tumor bulk for symptom control and possibly control o...
Has NRG-CC009 changed your approach to offering SRS over HA-WBRT as the preferred treatment for patients with brain metastases from small cell lung cancer?
Yes, it has. The authors and NRG are commended for completing this pivotal trial. We were offering MDACC SRS in select cases based on an ongoing clinical trial there as well. NRG-CC009 trial will establish a standard for SRS as the preferred modality for patients with SCLC in cases where patient sel...
Have you encountered severe truncal and bilateral lower-extremity edema after pelvic radiation for a rectal neuroendocrine tumor?
I have seen something similar after radiation to the lower retroperitoneal nodal chain, where there was likely progressive fibrosis that obliterated the lower IVC to the point that nothing could be done. Also, it is possible, albeit very unlikely, that rectal NETs produce serotonin in sufficient qua...
What factors do you take into account when deciding the length of adjuvant temozolamide in GBM?
The field is evolving from 12 cycles to 6 for IDH-wildtype GBM in recent years, on the basis of some retrospective studies and notably the prospective Spanish study GEINO 14-01 - there does not seem to be much OS benefit, and there are also toxicity concerns (myelosuppression, hypermutation). Extens...
How, if at all, do you anticipate incorporating Pixclara PET into the evaluation of suspected recurrent or progressive glioma after treatment?
In pediatric high-grade glioma, I think there's an opportunity to use it selectively when conventional MRI leaves uncertainty between true progression and treatment-related change (pseudoprogression), rather than as part of routine surveillance. The clearest need is in diffuse midline glioma after r...
Should ultra-short course RT be standard for elderly or poor performance status patients with glioblastoma?
The recent phase III randomized trial published by Roa et al. examining the efficacy of short course radiotherapy in elderly and/or frail patients with newly diagnosed GBM builds upon his previous work finding equivalent outcomes in elderly patients (age > 60 years) receiving 60 Gy in 30 fractions ...
Do you ever treat cervical nodes above the standard supraclavicular field for breast cancer patients?
In the setting of biopsy-proven supraclavicular or cervical nodal disease, I do extend my fields cranially to include these nodes. I typically include the entire neck level based on head and neck contouring atlases and extend the cranial border at least 1 cm superior to the highest node. If nodes ar...
What dose constraints do you use when treating a patient with bilateral breast cancer with RNI?
This article highlights lung, heart, esophagus, and dose homogeneity constraints we aim for when treating bilateral breast cancer and RNI. Li et al., PMID 41272934
How do you counsel patients with newly diagnosed advanced cancer on smoking cessation?
Unless the patient has a significant chance of living for more than a year or two, I can’t imagine that the difficulty of quitting smoking is really justified for that patient.
How do you manage bothersome diplopia due to metastatic disease affecting occipital lobe?
An isolated occipital lobe lesion should not result in strabismic diplopia (relating to misalignment of the eyes) unless a resulting loss of peripheral field reduces the drive for fusion and decompensates an underlying strabismus. The fact that it does not go away with monocular occlusion suggests i...