Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat SNUC?
There’s no standard treatment. Suitable for gross total resection: surgery and postop RT and concomitant chemo.Not suitable for GTR: chemo RT or induction chemo and reevaluate for surgery and postop RT chemo.
Is FAST-Forward/ultra-hypofractionation suitable for an early-stage breast patient after a lumpectomy with oncoplastic reduction?
Yes, FAST-Forward is fine after oncoplastic reduction as long as dose homogeneity criteria can be met (V105 < 5%).
What dose and OAR constraints do you use for boost with IMRT or SBRT when a patient with cancer of the cervix is not a candidate for brachytherapy?
Concurrent chemoradiotherapy plus brachytherapy boost (intracavitary or interstitial) is the standard of care in patients with locally advanced cervical cancer. In light of published data suggesting inferior survival if brachytherapy is omitted from definitive treatment, we do not recommend utilizin...
For locally advanced adenocarcinoma of the maxillary sinus, how should the neck be managed?
ENI if high grade
Would you add a brachytheray boost to a locally advanced cervical cancer after surgical resection and pelvic RT?
In general, a brachytherapy boost following external radiation is not standard when treating women for locally advanced cervical cancer post hysterectomy. Neither of the 2 major adjuvant GOG trials (92 and 109) allowed a brachytherapy boost, and even the currently open GOG trial, GOG 263, does not i...
What approach do you take to determine dose constraints for conventionally fractionated reirradiation of the head and neck?
Great question, very challenging scenario.In general, try to minimize the margins for re-RT, and use IGRT, especially if you are close to the neurologic critical structures. (Optics, brainstem, spinal cord, plexus, temporal lobe.)Specific doses and whether you exceed limits: that really depends on w...
Would you consider starting immunotherapy concurrently with whole brain radiation for newly diagnosed metastatic (BRAF negative) melanoma with multifocal symptomatic brain metastases?
This is a challenging clinical situation. In part, the approach depends on the number and size of the CNS lesions. However, I do not recommend the use of WBRT for my patients, as it has not demonstrated a survival benefit. In addition, in the adjuvant trial comparing WBRT to observation, it did not ...
What are the indications for adjuvant radiotherapy for basal cell carcinoma of the skin of the head and neck?
I rarely give adjuvant radiotherapy for resected BCCs because there is little data demonstrating a benefit. For BCCs, with squamous features or nodal metastases, I generally manage as a cSCC. Some reasons to consider adjuvant RT to resected BCC primary tumor might be: -T3/T4 primary (by AJCC 7) -R2 ...
What is your preferred method of surveillance after mastectomy?
The answer depends on clinical circumstances. For all the details, I refer you to NCCN guidelines where this is discussed specifically. However, let me summarize a few key points. Patients are usually seen several times a year for 5 years, less often thereafter. A history and physical exam is always...
What are your top takeaways in Head & Neck Cancers from ASTRO 2024?
Here are my impressions from 3 interesting presentations related to head and neck cancer: S2-S3, Yom et al., Interim futility results of NRG-HN005 a randomized phase II/III non-inferiority trial for non-smoking p16+ oropharyngeal ca. The study tested non-inferiority regarding DFS of two de-escalate...