Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend post op radiation therapy for a primary pulmonary synovial sarcoma which underwent lobectomy?
Preop RT would have been worth considering, but I don't see a role for postop RT in the thorax given negative margins and the extent of the field that would be required. It is unclear why neoadjuvant chemo was not considered for a large high grade tumor, but would at least ensure the patient sees me...
What dose constraints do you use when treating gastric MALT or DLBCL with radiation therapy?
Treatment of the entire stomach is recommended for gastric MALT lymphoma. A dose of 24-30 Gy is recommended, generally in 1.5 Gy fractions to limit acute toxicity. I am starting to utilize 24 Gy more frequently though, most studies have used 30 Gy. Gastric MALT tends to be multifocal, is not well vi...
How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?
I subscribe to the philosophy of "hitting hard, tapering slowly" for cases of pneumonitis, either radiation pneumonitis, or checkpoint inhibitor-related pneumonitis (some of those cases probably have mixed origin, with contributions from radiation and/or checkpoint inhibitors). For severely symptoma...
How do you manage squamous cell carcinoma in situ of the anus?
The first question I always ask when I get a case of in-situ squamous cancer is it reallly in-situ? If the physical examination suggests an invasive cancer or if the visible disease is very superficial but extensive, then it may be a sampling error and a few more biopsies are indicated.Assuming that...
How would you treat single celiac focus of adenocarcinoma of unknown primary?
Given the high rates of local control and favorable toxic effect profiles of SBRT, I will treat it with SBRT. Some retrospective research studies and small phase 2 randomized clinical trials have reported overall survival or progression-free survival benefits specific to localized metastatic tumor a...
Would you offer reirradiation for a patient who had prior MammoSite PBI?
Based on the effect of the previous RT, I have treated and favored 40 in 15 whole breast.
How do you manage the chemotherapy portion of chemoradiation in a patient with stage IIIB (hydronephrosis) cervical cancer, on hemodialysis?
I will make sure to discuss with the patient's nephrologist to see if there are any special considerations, but in general, it is safe to consider either carboplatin or cisplatin with appropriate dose medications while on hemodialysis. In managing these patients, I have found most nephrologists pref...
Do young, early-stage breast cancer patients with pCR to chemoimmunotherapy still benefit from PMRT?
As far as I am aware, it is not part of the usual practice to offer PMRT in the setting of T2N0 TN breast cancer. Though I think it may be considered as an "out of the box" recommendation in the setting of multiple high-risk features (larger T2 size, poor response to neo-adjuvant tx, LVI, young age,...
How would you approach a T1N1 NSCLC with a small peripheral primary tumor and single hilar node in a patient not fit for concurrent chemo or surgery?
If the patient were not a candidate for surgery or chemotherapy, then I would favor hypofractionated radiotherapy to 60 Gy in 15 fractions to both the primary and the hilar lymph node based on UTSW phase I data. If the patient may be a candidate for immunotherapy, then I would strongly consider enro...
For a young patient with high grade pT1N0 medially located breast cancer, under what circumstances would you include the IMN in your treatment fields?
For patients treated with upfront surgery who are T1N0, I personally do not radiate the lymph nodes, even in young patients with high grade lesions. An exception could be in patients with extensive LVI where the likelihood of nodal involvement is higher. For patients with initially more advanced dis...