Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with metastatic colorectal cancer to the lung and liver, is there a role for liver directed therapy if the lung is not amenable to local therapy?
This is a heterogeneous group of patients, so I don’t think there is one answer applicable to all clinical situations. This is why it is so important that these patients be discussed in a multidisciplinary setting. I’m assuming that in this situation the patient has had adequate systemic therapy to ...
Would you offer postoperative RT for pT2pN0 rectal cancer with close distal margin (within 2 mm) and only 6 lymph nodes obtained from surgery?
I assume the question is about the addition of chemoradiation in this setting. In this case, there is one clear reason to consider post op chemoradiation - the 6 LNs removed. This is clearly short of the standard for adequate lymphadenectomy of 12. It may be possible to ask the pathologist to review...
How do you incorporate radiation therapy in patients undergoing CAR T-cell therapy for DLBCL?
It depends on the circumstances of the patient, but there are three emerging indications for RT in the setting of CAR T-cell therapy: Tumor debulking prior to CAR T-cell infusion Bridging therapy between apheresis and CAR T-cell infusion Salvage of refractory, progressive or relapsed disease follow...
How would you define your radiation treatment volume for a primary diffuse large B-cell lymphoma of the L4 vertebral body that had a complete response to chemotherapy?
For a primary DLBCL involving only the L4 vertebral body with a CR after chemotherapy, we would include just the involved L4 vertebral body. There is no need to include one vertebral body above and below. Effort should be made to reduce excess dose to the bowel and adjacent bone marrow with either a...
Would you treat rectal squamous cell carcinoma the same as rectal adenocarcinoma, stage for stage?
No, I will treat rectal squamous cell carcinoma the same as anal squamous cell carcinoma, with definitive chemoradiation with 5FU/mitomycin. If the cancer invades the posterior vaginal wall or prostate, I will also include external ilac nodes. If the tumor involves lower rectum/anus, I will also tre...
For a patient with locally current endometrial cancer whose disease had complete radiographic response to carboplatin, Taxol, and pembrolizumab, would you consider adding radiation therapy?
Despite having a complete response to chemoimmunotherapy, I would tend toward adjuvant RT since this was a local recurrence. We don't have long-term data with chemoimmunotherapy in this locally recurrent setting.
Would you consider repeat lumpectomy and external beam partial breast reirradiation for in-breast recurrent cancers?
Patients experiencing a localized recurrence in a breast previously treated with lumpectomy and whole breast radiation are appropriately offered salvage mastectomy with or without reconstruction as an acceptable standard. However, many patients wish to have options that preserve the breast. Repeat l...
Do you treat elective nodes in unresectable pancreas when treating with 15fx?
No, the standard has been to include only grossly enlarged node, so for now we do not include elective nodal irradiation. We will re-evaluate this practice when we have more data and are better able to assess the pattern of disease progression. We are treating over 100 cases a year uniformly, so thi...
When would you offer post-op radiation for the treatment of sebaceous carcinoma of the eyelid?
I think of them as poorly differentiated and it’s a location where margins are likely close so always.
After wide local excision of a DecisionDx-SCC Class 2A cutaneous SCC of the posterior inferior scalp, would you irradiate nodal basins?
Yes, if I were going to irradiate the operative bed. I do not know prospective data on the use of adjuvant radiotherapy for nodal basins only in squamous or basal cell skin cancers, Cf. Porceddu et al., PMID 25993217, where a minority (5%) of patients are at risk for relapse, typically locally or re...