Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What treatment fields do use for heterotopic ossification prophylaxis?
This is what I was told at HSS- Bridging ossification between the greater trochanter and pelvic bones locks the leg- this is the most important area to cover. Bridging ossifcation between the lesser trochanter and pelvic bones, I believe, presents a much more minor impairment. You dont have to block...
What volumes do you treat for unresectable tracheobronchial cancer?
There is not a lot of literature on the management of primary tracheal cancer, since it is primarily a surgical disease. In the setting where the patient is inoperable or unresectable, then by first principles since it is an aerodigestive cancer, one can extrapolate the role of radiotherapy and chem...
In patients with oligometastatic disease, would you offer SBRT to a metastatic lymph node abutting the trachea and/or esophagus?
I have treated oligometastatic lymph nodes abutting esophagus and trachea. I do not do this routinely and the risks and benefits need to be weighed in terms of whether the patient is truly oligometastatic and if there are potentially effective systemic options.For these ultracentral locations, I fav...
How do you counsel patients regarding alcohol consumption following treatment of head and neck cancer?
I always tell patients that there is no known safe amount of alcohol consumption, especially regarding the risk of developing another head and neck cancer. Most patients who consume alcohol after head and neck radiation therapy often tell me that it does not provide the same enjoyment as before due ...
How would you sequence adjuvant chemo-immunotherapy (paclitaxel/carbo/pembro or paclitaxel/carbo/dostarlimab) with EBRT and vaginal cuff brachytherapy in advanced uterine cancer that meets clinical criteria for both EBRT and chemo-IO?
A common misapplication of RUBY/GY018 is giving IO in patients with non-measurable advanced uterine cancer. Radiation as part of the trial was not included in these studies. The role for chemo-IO vs chemo alone (with or without radiation) for high risk non-measurable uterine cancer was tested in GOG...
Given the results of KEYNOTE-A18, do you plan to recommend adding pembrolizumab to primary chemoradiotherapy for advanced stage cervical cancer?
Until the paper gets published, we won't really know a lot of details that may influence the potential utility of this regimen. It has an abstract/presentation and has recently received FDA approval.It is a relatively 'newer' idea in improving outcomes that we as an institution are open to start off...
Would you consider radiation omission for a patient with a Stage I breast cancer with an elevated Oncotype Dx?
I would offer the patient treatment based on the fact that she is in her 60s with a presumably long life expectancy, a high grade lesion, and radiation will lower her risk of local recurrence significantly. Even with a lower Oncotype, radiation will lower the risk of recurrence significantly accordi...
If a patient has distal esophageal adenocarcinoma and a PET+ left supraclavicular lymph node, and nothing in between, would you cover the entire esophagus? Both supraclavicular fields?
My experience is anecdotal. I have often seen nodal spread from the paraaortic or GEJ nodes skip to the supraclavicular nodes with nothing in between. Since treatment of the entire esophagus would not be tolerated by most patients, I have elected to treat standard volumes and the involved SC nodal s...
How would you manage a large area of multiple, recurrent cutaneous squamous cell carcinomas of the scalp with ulcerations and non-healing areas despite cryotherapy, multiple Mohs procedures, and 5-FU?
Consider sending the patient to medical oncology for evaluation for cemiplimab. Large areas of the scalp can also be treated by making a 1 cm "cap" of bolus and utilizing VMAT to cover scalp soft tissues, with elective coverage of nodes and perineural pathways if indicated.
How have the results of the phase III RTOG 0631 trial impacted your use of spine SBRT?
NRG/RTOG and the investigators are commendable for completing this important trial and reporting the outcomes. The possible reasons for the negative results of the SBRT arm were discussed in the plenary session at ASTRO 2019 and in the Discussion section of the JAMA Oncol paper by the authors. This ...