Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for selective arterial embolization of RCC before primary SBRT?
An interesting question! A good way to approach this question is with a list of potential advantages and a list of potential disadvantages. For the record, this is all hypothetical. I am not aware of any published literature that has explored this concept.Advantages: Significantly reduce the size of...
How does positive peritoneal washings factor into your treatment decisions regarding pelvic radiation and/or chemotherapy?
At this point, for patients who lack other adverse factors, we do not change management based on positive cytology for endometrioid histology.
In a patient with anorectal SCC, T2N0, with a history of bladder prolapse managed with pessary, would the pessary need to be removed prior to radiation?
I don't see a problem having a pessary in place at the time of each treatment, if the patient needs it in place in order to function. To reduce the risk of long-term vaginal stenosis, these patients should also have a vaginal spacer inserted at the time of each radiation treatment to better spare th...
What is your radiation approach to metastatic pancreatic tail adenocarcinoma s/p gem/abraxane and FOLFIRI now with an oligo-progressive LUL lung metastasis?
I certainly would favor metastasis-directed therapy with SBRT, given the PFS benefit observed in EXTEND, and I think the case for utilization in the oligoprogressive state is even stronger pan-tumor compared to consolidative treatment. I'd treat 50-55 Gy/5 fractions or could consider fractionating o...
When in the treatment of OA do you think it is optimal to offer LDRT?
Evidence reality check: Two well-conducted sham-controlled RCTs (hand and knee OA) were negative for clinically meaningful benefit at their primary endpoints. (Minten et al., PMID 30231990, Mahler et al., PMID 30366945). ArthroRad (multicenter randomized, single-blinded) compared standard-dose vs ve...
What is your treatment approach for a pediatric patient with H3K27M-mutant diffuse midline glioma following progression after radiation therapy?
First, if the patient is at least six months from initial radiation and has had a reasonable initial response, reirradiation is the best proven treatment for recurrence. We would also encourage enrollment on a clinical trial (the DMG National Tumor Board is a helpful resource for determining for whi...
What is your preferred treatment for non-contiguous Stage IIA Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL)?
Prognosis of patients with early stage NLP-HL is excellent with any treatment, and multi-institutional studies have shown 5-year survival rates of 98% (Michael S. et al. Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG. Blood 2020; 13...
Should hydroxychloroquine be stopped prior to standard or hypofractionated breast treatment?
We don’t stop hydroxychloroquine for RT.
Would you omit IMN coverage in cN1 TNBC with a CR after neoadjuvant chemo?
My practice has been to offer RNI in patients with cN1 disease with pCR in axilla outside of a trial. For TNBC in this situation, I would absolutely include IMNs in my RNI fields.
How do you manage moist desquamation when treating vulvar cancer?
My experience is largely limited to the treatment of gynecologic malignancies, with the treatment of vulvar lesions the most common reason for development of moist desquamation. The first goal, in my opinion, is to prevent development of moist desquamation as much as possible. Skin folds that are no...