Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a patient with cN1 MIBC, treated with neoadjuvant cisplatin-based chemotherapy with outstanding clinical response, who is no longer a cystectomy candidate?
This is certainly a not uncommon clinical scenario in practice with, unfortunately, limited prospective data. The ECOG ACRIN INSPIRE trial (EA8185) is aiming to generate key prospective data in this setting. For patients with node positive patients and great response to initial systemic neoadjuvant ...
What recommendations do you give to patients who ask about diet during breast cancer treatment?
Women with breast cancer are at risk of gaining weight during treatment. It is the perfect storm: Decreased activity and increased appetite from the steroids. Sometimes women think they are going to loose weight so they compensate - so informing patients of the risk is a first step. There are numero...
Do you offer adjuvant treatment for resected colloid pancreatic carcinoma?
I rarely offer adjuvant radiation for typical pancreatic ductal adenocarcinoma except in cases of positive margins, and then only after an adequate duration of chemotherapy has been given. Therefore, I do not think adjuvant radiation therapy should be routine in colloid pancreatic carcinoma, which i...
Is there a role for dose escalation beyond 50.4 Gy in neoadjuvant chemoradiation therapy for rectal cancer?
There are probably a variety of opinions about this, but there is no proven role for doses higher than 50.4 Gy. Doses between 50Gy and 60Gy have been studied extensively, including a PhII trial reported by RTOG that was negative for pCR endpoint with 59Gy, and there is no dose response within this r...
How do you approach elective nodal irradiation in muscle-invasive bladder cancer?
The evidence regarding elective nodal irradiation (ENI) in patients undergoing organ preservation with chemotherapy and radiation is mixed, especially when considering data from surgical studies. A meta-analysis involving approximately 17,000 patients indicated that nodal dissection improved outcome...
Is reirradiation in the setting of DCIS of the breast ever appropriate?
If the question means DCIS as IBTR after previous surgery and RT, then would say, would follow the same criteria as IDC for reradiation. Long DFS (at least 2 years but prefer longer) from previous RT, able to get repeat lumpectomy with negative margin with reasonable cosmetic outcome, suitable for P...
How do you approach treatment of a subtotally resected low grade glioma in a young patient?
The management philosophy for LGG is radically shifting. For years, the belief was that these were essentially "incurable", slow-growing tumors, and hence the original debate centered around observation versus resection; the observation camp is now squarely in the minority. The debate then shifted t...
Are there any unique considerations for treating pediatric high grade glioma?
Trial availability, disease extent, age, specific molecular alterations, and family history should likely all play a role in choosing the most appropriate treatment paradigm.It’s expected that most future studies in pediatric high grade glioma will be stratified by their nascent biology, given that ...
Would you offer hypofractionation for a larger AVM?
When treating large (or giant) AVMs the dose-volume relationship can be unfavorable when using a single-session radiosurgery, resulting in high complication rates for effective dose. The obliteration rate for large AVMs treated with single fraction SRS is low (less than 50%). For this reason, other ...
Do you use any dose constraints for the spleen while delivering abdominal radiation therapy?
The prognostic impact of post-RT lymphopenia on overall survival has been suggested by studies in esophageal, lung and pancreatic cancers (among others).Sunil Krishnan and others at MDACC looked at the relationship between degree of post-RT lymphopenia and mean splenic dose for patients with pancrea...