Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach radiation for an elderly patient with pT2N1 TNBC s/p MRM and ALND who refused chemo-immunotherapy?
RT will offer improved local control in this patient, as she has an elevated risk of LRR (positive LN, triple negative, large-ish T2, grade 3, LVSI). It will be unlikely to change her survival, as the data for PMRT did not show survival benefit until the chemotherapy was good enough to decrease dis...
What is your approach in deciding to include the entire tongue or a smaller volume (tumor surgical bed + margin) for adjuvant radiation in oral tongue cancer?
I would treat the large majority of the tongue, unless I had a very good method to immobilize the tongue (which I do not have; a bite block is not enough).
Is it safe to continue capmatinib during palliative radiation to a bone lesion in patients with metastatic lung cancer?
This a great question, and to my knowledge, there is no good literature (prospective or retrospective) to guide the treatment decision. That said, we have anecdotal experience continuing capmatinib during palliative radiation to osseous metastases, and that is the approach I favor.
How would you treat a gliosarcoma s/p GTR with leptomeningeal spread?
This is an extremely challenging clinical situation. The overall annual incidence of gliosarcoma in the US is <250 cases. These tumors, which usually contain both an astroglial and a sarcomatous cell population have a propensity to spread throughout the CNS, using CSF flow pathways, and hence leptom...
What is a reasonable dose to treat the entire bladder for an muscle invasive, multi-focal bladder cancer in a non-surgical patient?
A variety of dosing schemes have been used in bladder-sparing trimodality (TMT) experiences from the US (RTOG/NRG trials) and the UK (BC2001 and BCON trials). In BC2001, one of the randomizations in the 2 x 2 design was to treatment of the entire bladder to the prescription dose (64 Gy in 32 fractio...
Do you prefer IMRT to 3D for partial breast treatment?
Prefer IMRT for better conformity, dose homogeneity, and less dose to uninvolved breast. Lung dose is not a clinically meaningful difference.
Do you routinely perform a breast boost after whole breast radiation?
In the setting of close margins, I would utilize a boost (after confirming that re-excision is not planned). More generally, I boost all patients <age 50 and older patients with higher risk features such as high grade disease, hormone negative disease, larger tumor size, and close margins where re-e...
Are there any accruing trials in the U.S. evaluating selective use of radiation after mastectomy in early stage breast cancer?
The SUPREMO trial results have not yet been presented or published. There are no trials currently open in the United States randomly allocating patients who have had up-front surgery between PMRT and observation. There is such a study in South Korea, entitled "Postoperative Radiotherapy in N1 Breast...
What dose/fractionation would you use for a multiply recurrent and now unresectable ameloblastoma involving the masticator space, pterygopalatine fossa, and right maxillary sinus?
70 Gy/35 fractions. If SCC component, treat the neck.
For a T1 true vocal cord cancer that is p16+ would you use standard dose (63 Gy in 28 fx) or use a lower dose of radiation?
Same.