Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat an axillary presentation of a breast cancer in the absence of a breast primary?
In the era of MRI these have become rare as sensitivity of MRI is high. Our approach is to treat breast and RNI with no mastectomy as reported LR is low with this approach
What are the advantages/disadvantages of using static IMRT vs VMAT when treating breast cancer?
I think like most disease sites, you gain conformity and possibly more homogenous dose, while the low-dose bath increases. For PBI, I strongly prefer VMAT rather than mini-tangents with FIF (a type of IMRT). I have not found tangential inverse-planned RT to be beneficial in these cases. The VMAT pl...
What dose and fractionation would you use for a non-operable solitary fibrous tumor in the lumbar vertebra with definitive intent?
I remain unconvinced that protons offer better high-dose dosimetry (unless you believe in the shower/bath theory). Max dose will be less with fancy IGRT/IMRT (like 2 Gy a day Cyberknife). There might be no spinal cord, so you might be able to push the dose. I have no experience in such SBRT, but it ...
How would you manage a recurrent cervical cancer previously treated with vaginal cuff brachytherapy and has had a complete response to chemo-immunotherapy?
Ling et al., PMID 30600093 -The paper gives our philosophy in this scenario. The total dose is the function of dose to target and cumulative dose to rectum and bladder. To be able to give a higher dose with brachy, generally would favor around 30.6 Gy with EBRT and then limit the last 14.4 Gy to the...
How would you treat a p16+ squamous cell carcinoma confined in the recto-vaginal septum with no suspicious adenopathy on PET or MRI?
Early vaginal or anal cancer still has relatively high rates of lymph node involvement. In vaginal cancer, T1 lesions have lymph node involvement rates of 5 - 15%. In anal cancer, T1 lesions have a higher rate of 5 - 50%. If there are no mucosal changes then it is possible this is an in-transit LN f...
Would you recommend adjuvant radiation for a patient with head/neck merkel cell carcinoma following a pathologic complete response to neoadjuvant immunotherapy?
In CheckMate, after neoadjuvant IO and surgery, RT was recommended as part of care irrespective of response. Whether in patients with pCR, it added to the outcome is hard to say, as it was not randomized. We favor RT unless pre-IO disease was localized, small, and node negative.
What is your treatment approach for patients with base of skull glomus jugalare tumors (paraganglioma)?
Depending on the patient's performance status, size of tumor, and location within the skull base, I may opt for radiosurgery upfront or simply external beam radiotherapy. For radiosurgery, typically my dose is 16 Gy and for external beam may range from 45 to 50.4 Gy.
How would you approach a patient with a carotid body tumor and metastasis to the cervical lymph node?
All such patients should be evaluated by a qualified otolaryngologist for removal of the primary tumor and the affected lymph nodes with a selective neck dissection. Surgery is considered the primary treatment for cure. For incomplete resections, adjuvant radiation therapy should be considered for i...
How should you approach treating curable laryngeal cancer with chemo-RT in a patient who had a myocardial infarction during treatment and requires CABG, given the cardiotoxicity of cisplatin and 5FU/carboplatin?
Wow - tough situation. I would largely be hesitant to give chemo to someone who requires a CABG, which also implies that stents were not placed, etc. I would also want to know if it was a STEMI or not, angiogram results, EF, etc. I think the stage of the cancer, other comorbidities, goals of the pat...
Given the results of ESOPEC from ASCO 2024, for which patients with resectable esophageal adenocarcinoma would you favor neoadjuvant chemoradiation?
It is a great question and something that I think all of us are still wrestling to digest and readjust our treatment algorithm for patients with esophageal cancer. First, I think Dr. @Dr. First Last did an outstanding job putting ESOPEC in context in the esophageal cancer treatment landscape. In add...