Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat an unresectable eccrine carcinoma of the skin of the face?
I would prescribe 63 Gy in 35 fractions 250 kvp with a Thoreaus filter and lead collimation on the skin and elective neck RT with 6 MV using an AP field. If it is too extensive for orthovoltage, I would recommend IMRT or protons depending on location and extent.
What are your top takeaways in GI Cancers from ASTRO 2024?
Neoadjuvant Chemoradiation (CROSS) vs. Perioperative Chemotherapy (FLOT) in Esophageal Adenocarcinoma (EAC): ESOPEC – a Randomised Controlled Prospective Multicentre Phase III Trial published in issue: October 01, 2024 S6 Has now changed the standard of care for adenoCA of the esophagus. CROSS appro...
When do you recommend endocrine therapy for chemoprevention in women with high-risk benign breast lesions?
Women with atypical hyperplasia or lobular carcinoma in situ have a 4-10 fold increase in breast cancer risk. In the randomized controlled trials of endocrine therapy for chemoprevention for 5 years, this subset of women with high-risk benign breast lesions had up to a 60-70% relative risk reduction...
In the case of a thoracic esophageal cancer that will require extensive volume coverage, >2/3 of the esophagus, do you prophalactically prescribe a feeding tube or observe?
I am not a big fan of stents and working with the University of Utah team we published on this issue (Francis et al., IJROBP 2017). For a series of 103 consecutive patients treated with definitive or neoadjuvant chemoradiation (CRT), of whom 28 had a stent in place during the chemoRT, we found that ...
Does pathologic complete response impact your selection criteria for tumor bed boost of breast cancer patients' status post neoadjuvant chemotherapy and breast-conserving surgery?
I have not used response, including pathologic complete response, as a reason to change my criteria for tumor bed boost following neoadjuvant chemotherapy. I typically will boost patients that meet at least one of the following criteria: age <50, ER-, cT3, grade 3, LVSI.
What is the significance of PNI in oropharyngeal cancer?
Perineural invasion (PNI) is a risk factor for local recurrence for oropharyngeal cancers (Routman et al., PMID 28847412). I have infrequently seen gross named nerve invasion with OPX tumors, so it is usually an intermediate risk factor. When named nerve invasion does occur, it is generally hypoglos...
How do you counsel an early stage breast cancer patient with lupus regarding decisions on radiation?
The data with lupus and RT is not consistent and most recent data suggest good tolerance to breast RT. I have them continue on medication for lupus and counsel them that acute morbidity and late effects appear to similar although there is some chance it may be enhanced but not contraindication to RT...
When would you consider radiation therapy for an optic pathway glioma in a pediatric patient?
Only if all previous lines of chemotherapy or targeted agents have been exhausted or failed.
Would you use neoadjuvant TKI or neoadjuvant radiation for a large chest wall sarcoma with an NTRK fusion on NGS?
Although there is no data to support the "neoadjuvant" use of NTRK inhibitors in NTRK-fused sarcomas, the rapidity of response to this approach is amazing. There is also a school of thought that the use of NTRK inhibitors in NTRK-fused sarcomas affords a durable response. My experience is different....
Is there any role for radiation in the treatment of stage II nasopharyngeal DLBCL involving bilateral nasopharynx and unilateral cervical nodal involvement but without bony or nerve involvement?
The role of RT in the rx of stage II DLBCL, either nodal or extranodal in type, remains controversial with NCCN guidelines allowing for either approach. There is agreement that initial therapy should be systemic, typically R-CHOP at present. For patients achieving CR (PET-negative), we routinely use...