Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend adjuvant radiation for a patient with head/neck merkel cell carcinoma following a pathologic complete response to neoadjuvant immunotherapy?
In CheckMate, after neoadjuvant IO and surgery, RT was recommended as part of care irrespective of response. Whether in patients with pCR, it added to the outcome is hard to say, as it was not randomized. We favor RT unless pre-IO disease was localized, small, and node negative.
How would you approach a patient with a carotid body tumor and metastasis to the cervical lymph node?
All such patients should be evaluated by a qualified otolaryngologist for removal of the primary tumor and the affected lymph nodes with a selective neck dissection. Surgery is considered the primary treatment for cure. For incomplete resections, adjuvant radiation therapy should be considered for i...
How should you approach treating curable laryngeal cancer with chemo-RT in a patient who had a myocardial infarction during treatment and requires CABG, given the cardiotoxicity of cisplatin and 5FU/carboplatin?
Wow - tough situation. I would largely be hesitant to give chemo to someone who requires a CABG, which also implies that stents were not placed, etc. I would also want to know if it was a STEMI or not, angiogram results, EF, etc. I think the stage of the cancer, other comorbidities, goals of the pat...
Given the results of ESOPEC from ASCO 2024, for which patients with resectable esophageal adenocarcinoma would you favor neoadjuvant chemoradiation?
It is a great question and something that I think all of us are still wrestling to digest and readjust our treatment algorithm for patients with esophageal cancer. First, I think Dr. @Dr. First Last did an outstanding job putting ESOPEC in context in the esophageal cancer treatment landscape. In add...
Would you consider simulating a patient with brain metastases in the prone position if they are unable to tolerate lying supine for SRS treatment?
I have taken care of many sick and quite comorbid patients with brain metastases and have not yet run across the situation - mainly because someone with poor enough performance status that they cannot tolerate a supine positioning awake, or under anesthesia, is typically not an ideal radiosurgery ca...
Is there a risk of increased side effects with combined radiation and ibrutinib therapy?
It is increasingly common to see patients with various hematologic malignancies requiring palliative RT who are on small molecular inhibitors (such as ibrutinib) or other novel agents. There is often a dearth of information in the medical literature regarding the safety of combining RT with these dr...
How would you manage simultaneous locally advanced NSCLC and locally advanced head and neck cancer?
Agree with Dr. @Dr. First Last, however, if planning to treat these synchronously, I would favor two setups, one for lung and one for HN. I would want to keep doses in lung tight to minimize toxicity as much as possible. Having to fight with arms and butterfly arcs is going to make that much tougher...
What radiation dose is a risk for damaging function or active leads from a pacemaker?
Lots of attention has been placed on the dose to the device itself (and to a lesser extent the leads of implanted devices such as pacemakers). The type and purpose of the device are very important and plays a role in what is permissible dose to the unit. For example, the risk to a pacemaker (PPM) on...
How do you sequence thoracic consolidation RT and PCI with incorporation of immunotherapy in ES-SCLC?
In the IMpower133 study, "during the maintenance phase, prophylactic cranial irradiation was permitted as per local standard-of-care, but thoracic radiation with curative intent or the intent to eliminate residual disease was not permitted. Palliative thoracic radiation was allowed. (quoting from th...
Do you take the primary dissected site for postoperative oral cavity cancers with bony invasion to 66 Gy?
Dr. @Dr. First Last correctly addresses the nuanced indication for PORT due to bone involvement.60 Gy is embedded in the PORT culture. For at least 30 years, RTOG trials have recommended 60 Gy with an optional boost to 66 Gy for PORT, though the EORTC trial (Bernier et al., PMID 15128894) went to 66...