Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose do you use for single fraction SBRT when treating a small, peripheral early stage NSCLC?
There have been two randomized phase II studies of single fraction versus multi-fraction lung SBRT for medically inoperable early stage lung cancer patients. In RTOG 0915, 82% of patients were T1. In the Roswell Park Cancer Institute study, 86% of patients were stage IA. With that in mind, the curre...
For vaginal cylinder HDR in the setting of adjuvant endometrial cancer radiation, do you routinely alter the prescription dose based on the diameter of the cylinder?
The prescription dose will remain the same regardless of the size of the cylinder that is used and should be specified to the vaginal surface (often 6 Gy x 5) or to 5 mm depth (often 7 Gy x 3). Because of the inverse square law, the dose to the non-prescription point will vary as a function of cylin...
What is the appropriate treatment approach for a primary squamous cell carcinoma of the trachea?
Treating tracheal malignancies is obviously challenging. I typically determine treatment based on the location of the primary. Upper tracheal (above the sternal notch) I treat more like a HN cancer while below that I treat more like a lung cancer. Upper tracheal cancer are more difficult to resect d...
Do you hold nivolumab and ipilimumab when giving palliative radiation to abdominal targets?
This is similar to the question of whether you should hold bevacizumab for palliative radiation. You cannot really change the biologic effects of these agents immediately by holding them. The toxicity has been repeatedly shown to be minimal in trials where radiation has been included with concurrent...
What's your approach to adjuvant therapy for neuroendocrine (small cell) cancer of the parotid gland?
While it is rarely possible for a primary NE cancer to arise in the parotid, the vast majority of these are actually Merkel cell carcinomas (MCC) secondary to a skin primary in the draining zone of the parotid (or pre auricular nodes) in the face/scalp. Even if a primary were to be never detected, w...
How often do you believe para-aortic radiotherapy in addition to pelvic radiotherapy causes additional treatment breaks due to acute toxicity?
I would agree with @Dr. First Last that with IMRT and accurate definition of targets and organs at risk, that treatment can be delivered successfully. In patients who have had prior chemotherapy, attention to weekly blood counts is imperative. It is usually the platelet counts that pose a challenge....
What are your treatment volumes for patients with gastric cancer receiving adjuvant chemoRT for a positive margin following gastrectomy and D2 nodal dissection?
INT-0116 remains the only positive phase III trial showing a benefit to adjuvant chemoradiation for gastric cancer. Though very few of those patients had D2 dissections, unplanned subset analyses of 0116 and comparison to a contemporaneous Korean non-randomized trial in patients with D2 dissections ...
How do you approach pre-operative chemoradiation for vulvar cancer?
Over time, the approach shifted from administering preoperative doses to delivering more doses in the mid-60s. Biopsies are now conducted at 8-12 weeks for persistent abnormalities to define pCR and persistent disease, thus enabling tailored management (Richman et al., PMID 32981696).Also this abstr...
In light of findings from GOG 258, is the benefit of adjuvant RT in IIIC endometrial cancer worth the potential acute and late risks of RT in the setting of significant autoimmune disease?
I agree with the thoughtful answers of others in terms of tailoring therapy and balancing risk/benefit. In this case, however, GOG 258 answered the value of doing radiation on top of chemotherapy for any patient that met its criteria. And in this case, it included 75% that indeed had stage IIIC dise...
Would you recommend adjuvant neck radiation for metastatic chordoma to cervical lymph node, s/p neck dissection, with 1/10 positive nodes and no residual on post op imaging?
Yes