Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In patients with EGFR mutant L858R stage III NSCLC who are unresectable due to multistation N2 disease, would you consider upfront osimertinib over definitive intent CCRT?
This is a very complex question that is common among our thoracic tumor board discussions. I'll answer the latter question first. In this case, I would not offer consolidative durvalumab.There are data that immune checkpoint inhibitors (ICIs) have minimal to no benefit in the metastatic setting base...
Would you recommend additional post-operative chemoradiation for a T2N1 proximal rectal cancer having received adjuvant capecitabine/oxaliplatin?
Pathologic T2N1 after high-quality R0 TME, in an otherwise favorable pelvic risk patient (per pre-op staging MRI) with upper rectal cancer, would not be sufficient for me to recommend post-op CRT as I don’t think there would be a clinically significant benefit that would warrant the known acute and ...
When treating a high rectal cancer, does your coverage of the caudal mesorectum depend on the surgical plan?
The approach to rectal cancer treatment is influenced by factors such as tumor height, nodal status, and other high-risk features. Generally, I adhere to RTOG and international consensus guidelines, covering the mesorectum down to the pelvic floor. The RAPIDO study, although notable, demonstrated a ...
What is an acceptable distance between tumor and heart or aorta to treat a non-small cell lung cancer with SBRT?
I will echo @Dr. First Last's answer. Having used 50 Gy in 5 fractions now for over 10 years at the Cleveland Clinic, we have not identified cardiac or great vessel specific toxicities for the close to 400 patients we have treated with this schedule. Specifically in compiling our data registry, we h...
How would you approach a 2 cm malignant primary cutaneous adnexal adenocarcinoma of the axilla s/p resection with positive margin who is unable to undergo additional surgery?
I would consider imaging of the regional node basin (axilla) first. If there was evidence of regional lymph node metastasis, I would image the body to evaluate for distant metastases. If there was distant metastasis, I would probably refer for systemic therapy. If there was no distant metastasis, ...
How do you approach axillary radiation in a patient with breast cancer who did not have a sentinel node biopsy?
Choose wisely. The message from the surgery group discourages SNLN bx in 70 and above with low to intermediate grade pathology. As far as RT is concerned, AI alone, APBI, and 5 fraction whole breast are all reasonable options in those patients, and not having SNLN would not change recommendations. T...
Is it safe to deliver palliative spine radiation concurrently with sacituzumab govitecan?
There are simply not enough data to confirm the safety of concurrent sacituzumab govitecan and RT. As palliative spine RT typically entails a short course (cEBRT using 8 Gy in 1 fx or 20 Gy in 5 fxs or SBRT using 2-3 fractions) of treatment, holding the medication for a week during RT should not imp...
Will the recent publication of the MA.20 and EORTC 22922 studies in NEJM, showing no survival advantage from regional nodal irradiation in early-stage breast cancer patient following surgery, change your standard of care for these patients?
Two major landmark studies recently published simultaneously in the New England Journal of Medicine, Volume 373, 2015 (NCIC MA.20 study by Whelan et al. and the European Organization for Research and Treatment of Cancer (EORTC) 22922-10925 study by Poortmans et al.) will have a significant impact on...
In a patient with an N+ anal cancer on pre-treatment PET, should a PET scan be repeated in follow-up?
To answer the question directly asked, yes, I do. I find it to be valuable for treatment response, as outcome correlates with response. Personally, sometimes although test results may not be actionable (i.e. will not likely change immediate management), the "boost" a patient gets from knowing they a...
When treating anal cancer with VMAT or IMRT, do you use bolus?
I bolus the primary if I can see it on inspection in the treatment position. I do not usually use bolus for the inguinals unless there has been an excision or the tumor is involving the skin. In that case, I give a 5cm margin on the scar with bolus. I have seen several cases in the distant past of d...