Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you ever consider definitive thoracic RT with concurrent immunotherapy in Stage III NSCLC?
Generally speaking in my opinion, concurrent chemoradiation with a platinum drug doublet remains standard of care outside of clinical trials. Definitive chemoradiation in stage III lung cancer is considered a curative regimen despite the risks of local recurrence (around 30%) and distant mets. Bear ...
How would you manage a left sided triple negative breast cancer with a concurrent left sided locally advanced non-small cell lung cancer?
The presentation of two primary cancers that carry serious prognoses is very challenging. There are many variables at play here that could alter the initial therapeutic approach and ongoing treatment. Assuming this patient has a reasonable KPS, PFTs, and can undergo surgery, one way to start is neoa...
Would you offer adjuvant radiotherapy to a recurrent HPV-independent vulvar cancer located close to the anus, which was resected with very close (0.8 mm) margins?
I would favor RT and include the inguinal region as with local recurrence, there is about a 15% risk of nodal involvement.
How do you treat intact SCC of the subglottic larynx?
This is a very challenging subsite, for which most of us have less clinical experience than for glottic or supraglottic tumors, and for which the available published series are fewer and more heterogeneous.The most important recommendation I can make on this subject is to direct the reader to an out...
What dose-fractionation would you utilize to treat an oligometastatic rib lesion for durable local control?
Generally speaking - I tend to favor 35/5# for rib metastases, but as is the case with any oligometastasis scenario and SABR scenario the devil is in the details. Things to consider - 1. Why is the lesion being treated, is it a solitary met? If so, could consider a higher dose like 40/5 with the ai...
When do you offer radioembolization (Y90) in the treatment of unresectable HCC?
Y90 does have some more data of better LC than TACE but not with OS in the Brown meta analysis (Brown et al., PMID 35943116). I think for small tumors less than 5 cm, Y90 can be appropriate. I would not treat it for PVTT. The SARAH trial had a large majority with PVTT and was negative. As were Sorem...
What are your top takeaways from ASCO GI 2023?
Top 3 radiation oncology studies: Abstract 489- NRG/RTOG 1112 presented at ASTRO but only phase III study to establish the role of liver SBRT in HCC; will SBRT supplant radioembolization given the 3 negative phase III studies for radioembolization in contrast to this positive study for SBRT Abstract...
Would you offer adjuvant chemoRT for node positive high rectal cancer above the peritoneal reflection?
I would not offer RT to this patient. If you look at the data, the risk of local recurrence of rectal cancer decreases dramatically as the distance from the anal verge increases, and with proper surgery, is well under 5% (probably 1-2%) for tumors above 10 cm. It is not even clear that the tumor des...
Will you consider definitive concurrent chemoradiation for stage IV lung adenocarcinoma with metastasis limited to an internal mammary lymph node?
I'd certainly consider it upfront if lung and cardiac constraints can be reasonably met. There have been a few small series now demonstrating good outcomes in patients who received definitive chemoradiation to thoracic disease in the setting of limited metastatic disease. Generally, I would favor an...
Can APBI be integrated with oncoplastics?
If patients are having oncoplastic surgery, I typically do not offer PBI due to concerns about appropriately identifying cavity, particularly in situations of tissue rearrangement. I have offered to patients with reduction mammoplasty and a UOQ cavity where the cavity is intact with seroma and clip...