Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can post-lumpectomy radiation be omitted for ER/PR(+) low-volume (2 mm) low-int DCIS, with > 2 mm margins in a post-menopausal patient who will be taking tamoxifen?
This is an individualized decision weighing the benefits and potential toxicity. We know from many prospective trials that none of the clinical features mentioned sufficiently put the recurrence risk low enough (often defined as <10%) to omit radiation. However, radiation also likely will not have a...
How do you incorporate DCISionRT testing in the setting of close (<2 mm) or positive DCIS margins?
No matter how much Panera Bread they bring you, the answers are these: Positive margin? Surgical re-excision. <2 mm margin? Surgical re-excision. Why? Because the SSO guidelines say so. That's why. "But she doesn't want surgical re-excision for the positive margin." Ok. Then you recommend radiation...
Is DCISionRT appropriate for multifocal DCIS?
Decision RT principles can be applied to multi-focal DCIS also.
In what patients is it inappropriate to offer DCISionRT testing?
Appropriate or inappropriate... not quite how I think about it. Most of my patients come with it done. Here are various reasons why a low score won't change my mind about whether to treat or not. Large and high grade - i.e., >2.5 cm and grade 3. I don't feel comfortable omitting from this group. Po...
Is there a role for radiation therapy for florid LCIS managed with lumpectomy?
There is no role for RT for classical or florid DCIS. If it meets the criteria for pleomorphic LCIS, then would treat like DCIS with RT.
Would the presence of a close but negative pleomorphic LCIS surgical margin impact your decision for APBI in a patient who is otherwise a favorable candidate?
There are evolving data and ideas around pleomorphic LCIS with some consideration of treating it like DCIS (Savage et al., PMID 29894223; Desai et al., PMID 29947004).As such, I would consider this margin similar to a close DCIS margin. If there is invasive disease with this, I am fine with no tumor...
What follow-up imaging do you recommend after SBRT/SABR for lung cancer?
I generally take a more conservative approach for follow-up. Most guidelines do not recommend, in fact they discourage, routine PET-CT after definitive treatment of lung cancer. Therefore, for pure surveillance purposes I utilize chest CT only. My schedule is every 6 months for 2 years and annually ...
In which oropharynx patients would you recommend TORS vs upfront RT or chemo-RT?
With MC1675 and ORATOR2 coming out at ASTRO21, and ECOG3311 published shortly afterwards, this topic is now particularly germane. Due to the recent reports on these trials, I'll be writing in the context of possible post-op de-escalation.I think the first and most important question to ask is, "What...
For patients starting Pluvicto, do you have patients stop their ARPI?
While the VISION trial allowed for concomitant use, it was only about half (53%) in the Lu-177-PSMA arm, and 2/3 (68%) of those on the standard of care arm - Garje et al., PMID 36693228. And the PSMAfore trial did not, as noted above by @Dr. First LastThe bigger question is, will you continue the AR...
Would you offer a patient over 70 years old with early stage, favorable breast cancer adjuvant whole breast radiation if her sentinel node biopsy shows a single node with isolated tumor cell (ITC)?
ITC would not change my decision about AI alone vs. RT plus AI. If you decide to treat, then make some adjustment of the angle to include low lying nodes in the tangential beam but dont chase the nodal region.