Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does a negative staging PSMA PET in a patient with biopsy-proven recurrent prostatic adenocarcinoma change your management?
The bottom line is that you have to believe the biopsy. PSMA PET will not show microscopic disease, which is why it cannot "rule out" disease in lymph nodes or elsewhere. It is comforting when it is negative, but it is not absolute truth. A few questions; What was the PSA at the time of the PSMA PET...
Is it safe to give thoracic irradiation to a patient with lung cancer previously treated with a VEGF inhibitor?
We did a study in patients getting VEGF inhibitors and SBRT. Anecdotally we had seen some impressive (small bowel necrosis requiring surgery) and unpredicted toxicity and we were looking for a common factor that tied them together. VEGF inhibition was that common factor. These are all patients treat...
In oligometastatic NSCLC with a solitary brain metastasis and lung primary amenable to SBRT, how would you sequence first-line systemic therapy versus local therapy to the lung after treatment of the CNS metastasis?
Would generally favor appropriate first-line systemic therapy whether that be immunotherapy +/- chemo vs. targeted therapy and if at least stable disease at the next surveillance imaging (~3 months), go ahead and consolidate with SBRT. I don't think it would be wrong to do SBRT upfront here but the ...
When treating early stage breast cancer with adjuvant RT, what risk factors would lead you to include the level 1 and 2 axilla in patients with pN0(i+) disease?
I would not offer for pN0(i+) patients. It barely makes a dent in the patients that have an indication.
When do you offer PMRT for clinical T3N0 breast cancer with a pCR after neoadjuvant chemotherapy?
I think this is a very interesting question, and one about which we have relatively little data. For pathologic T3N0 disease treated with mastectomy, radiotherapy is reasonable (NCCN tells us to "consider RT") but, I believe, falling out of favor. Data from the NSABP suggest that the 10-year risk of...
What is the recommended treatment approach for stage III/IVA nasopharyngeal cancer that is p16 negative and EBV positive?
The recommended treatment approach for stage III/IVA EBV-positive nasopharyngeal cancer is induction chemotherapy with gemcitabine/cisplatin followed by concurrent chemoradiotherapy with cisplatin.This was established in a phase 3 trial that compared induction chemotherapy plus concurrent chemoradio...
What are your indications for including the contralateral neck when planning postoperative primary and ipsilateral elective neck radiotherapy for a well lateralized buccal squamous cell carcinoma?
No indication for contralateral neck RT in cases of buccal primary ca. If there are high risk features in the ipsilateral neck or primary tumor, LRR risk will mostly be confined to those sites.
What rates of radiation-induced secondary malignancies do you typically quote to patients in their 30s-40s?
This is an excellent question. Current breast cancer treatments yield great local control and overall survival rates; thus, leaving long term toxicity for breast cancer treatment as a major concern. As a resident, I often quoted patients the risk of secondary malignancies from radiation therapy to b...
Is PMRT routinely recommended for all patients with positive lymph nodes after neoadjuvant chemotherapy?
This is a good question. In general at MD Anderson, we tend to recommend post-mastectomy radiation therapy for patients with residual micro- or macro-metastatic disease in the axillary nodes after neoadjuvant chemotherapy. This recommendation is strong when the patient had clinical stage III disease...
When do you consider elective pelvic nodal irradiation for unfavorable intermediate risk prostate cancer?
I consider elective pelvic nodal irradiation for patients classified as unfavorable intermediate risk by virtue of having Grade Group (GG) 3 disease, especially if they have high volume disease (50% or more of the cores are positive). These patients have a risk of lymph nodal involvement that is in ...