Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How stringent or flexible are you with concurrent chemotherapy and radiation starting on the same day in the definitive CRT setting for HN patients?
I am OK with RT starting a day or two after chemo, usually we may need some extra time planning and doing the vsim, shouldn't really be a big deal with RT starting a little after since the chemo is a sensitizer and it will already be in the patients system when we start RT
Would re-excision of close margins (1 mm) allow a patient to avoid post-op radiation for a patient with metachronous diagnosis of a FIGO Stage IB vulvar cancer who also had a prior contralateral vulvar cancer resected 15 years ago?
Yes, would avoid RT if re-excision is done to get a wider margin.
How would you treat a high risk Merkel cell carcinoma of the lower leg after R1 re-resection who failed sentinel mapping?
This situation is very unusual. I can't recall ever seeing a patient have a failed sentinel lymph node biopsy procedure AND a positive margin after attempted re-excision of a Merkel cell carcinoma of the leg before. This leads me to wonder whether the patient should consult another surgical oncologi...
For Merkel cell carcinoma of the lower extremity with early isolated recurrence in the ipsilateral inguinal nodes, would you include pelvic lymph nodes in the post-operative field following inguinal lymph node dissection?
We have traditionally offered post op RT for all node positive MCC.We typically include the lower pelvic nodes (Ext Iliacs) and exclude bowel after 46 Gy by field reduction.
Would you treat the prostate alone, or prostate and mets in an oligometastatic prostate cancer patient?
It's a good question and we are tempted to answer "prostate and mets" as the literature is building up, but we are still waiting for randomized phase III trials. The evidence so far suggests that stereotactic ablative radiotherapy (SABR) is promising. SABR-COMET trial has shown an improved OS for SA...
How do you approach rising PSA many years after prostatectomy with negative PSMA PET?
The devil is in the details. What is the status of the patient? In other words, what is the expected survival of the patient given his age, performance status, and medical conditions? There are online calculators that can be used to help. At what PSA value was the PSMA scan obtained? The utility of ...
Is there data to support worse surgical outcomes in short course RT followed by surgery vs. long course chemoradiation followed by surgery in rectal cancer?
This question seems to be asking about surgical outcomes between short and long course radiation in both TNT and non-TNT approaches. With regards to the latter, the TROG 01.04 trial compared pre-operative short course RT to long course chemoRT. There was no difference in OS, LC, late toxicity, or su...
How do you treat locally recurrent papillary thyroid carcinoma following multiple surgeries/RAI?
This is a good question and fortunately depicts a clinical case we don't often see. Obviously as a surgical disease, the surgeon really needs to totally sign off on this case before stepping in with XRT. In this era with newer TKIs we often have the patient see the med oncol or endocrinologist with ...
Would you treat a uterine carcinosarcoma with omental spread with adjuvant whole abdominal radiation?
I would not offer any external beam irradiation for this patient. Even isolated omental spread in uterine carcinosarcoma represents metastatic disease. Thus, they only reasonable option is chemotherapy, usually systemic agents such as carboplatin and paclitaxel or cisplatin and ifosfamide.
For an otherwise resectable esophageal cancer with involved celiac lymph nodes, would you ever consider an SIB beyond 50.4 Gy?
Intuitively, it seems like 50.4 Gy is not enough, as pathologic complete response rates are low. Based on multiple randomized trials, no dose higher than 50.4 Gy has been superior to 50.4 Gy for esophageal cancer. This included the primary tumor and grossly involved nodes. The NCCN now recommends st...