Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend postoperative radiation for spinal cord compression DLBCL?
I would recommend postoperative RT, following completion of systemic therapy. I would restage with PET-CT prior to RT. If CR: 30 Gy would suffice.
Would you recommend post operative radiation in an adult patient with a thoracic spine osteosarcoma?
The following answer is extrapolated from AOST2032 which is a pediatric clinical trial but is relevant to the question at hand. This case touches upon the concepts outlined in the AOST2032 research protocol for osteosarcoma radiation therapy. While acknowledging this is just one protocol and not a ...
In the post Covid era, could the ILROG hypofractionated regimens (published as "emergency guidelines" for lymphoma) be considered as standard of care for ISRT?
In palliative settings, we have utilized hypofractionated regimens in hematologic malignancies for decades. Examples include 4 Gy X 1 for follicular lymphoma, 4 Gy X 5 for myeloma, 3 Gy X 10 for DLBCL, and 4 Gy X 2 for mycosis fungoides. In select circumstances (both before and after COVID-19), I ha...
How would you treat a symptomatic tongue metastasis?
It is a very broad question. Assuming wide spread mets from a subclavicular primary, I tend to favor standard palliative regimens, and in head and neck sites, I find a quad shot with potential for repeating 1 or 2 times if responsive, very appealing, especially in patients with poorer PS/poor progno...
How do you weigh upfront nodal burden when deciding to omit PMRT in a patient with cN1, ypN0 disease after neoadjuvant chemo, mastectomy and ALND?
Pre-chemo imaging if it shows 4 or more abnormal nodes (N2) then would offer RNI irrespective of response.
What clinical and pathologic features do you use to discern whether >= 2 synchronous lung nodules, biopsy proven lung adenocarcinoma, are different primaries versus metastatic disease?
These cases are always discussed at a multi-disciplinary tumor board with a review of pathology slides from the operative specimen. In some cases, there are clearly different morphologies or levels of differentiation. These can be initial clues, but not definitive to determine synchronous primaries ...
Do you recommend holding a KRAS inhibitor during palliative radiotherapy?
I have no personal experience or anecdotes and know of no current data or literature that would address this very specific question and this may be due to the limited experience on the potential interaction of this class of drugs and radiotherapy, since this drug is relatively new.This class of drug...
What are your top takeaways in Thoracic Cancers from ASCO 2022?
1. Abst 8502 - Quality metrics and survival after lung cancer surgery: More efficient work-ups and consistently high quality resections will likely do more to improve lung cancer survival than any adjuvant or neo-adjuvant therapy we can come up with. This is low-hanging, low-cost fruit. 2. Abst 9007...
What are your top takeaways in Thoracic Cancers from ASCO 2023?
Always so hard to pick a top 3 as luckily each ASCO provides us with a broad spectrum of significant advances in our field but if pressed against the wall, I might pick below 3: The first is a double dip choice I admit matching ADAURA with KN789. Of course, you need to be living in a cave not to be ...
Would you offer re-irradiation for recurrent vaginal bleeding?
Based on the previous dose, there is an opportunity for more doses for palliation. Dose and fractionation would be driven by KPS and expected survival. I have done quad shot, 30 in 12 to brachy in these situations based on the above.