Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach an in-field recurrence after lung SBRT for a T1 NSCLC in a patient with poor underlying lung function?
Explore non-radiation options, including any molecular testing to seek potential targeted systemic options. Still exhaust alternative local options such as cryoablation or local/wedge resection. Radiation option can still be considered if all other options are exhausted, considering the location (ce...
Is SBRT an option for a paravertebral lung cancer with vertebral body and rib invasion for patients who are not chemo candidates?
I do believe SBRT is an option for paravertebral lung cancer with VB and rib invasion. My rationale is that SBRT offers improved local control and cancer outcome compared to conventionally fractionated radiation - and that while there may be potential for increased toxicity of treatment in this scen...
Would you consider induction chemotherapy prior to starting chemoradiation therapy in squamous cell carcinoma of the esophagus?
Time and again, studies have shown that induction therapy for squamous cell carcinoma, seemingly regardless of primary tumor origin, probably does not improve the outcomes for patients compared to upfront chemoradiation therapy. For example in Head & Neck squamous cell cancers, the use of induction ...
Would you avoid radiation in a patient with breast cancer with active skin lupus?
In a patient with active skin lupus, I would counsel regarding the risks of radiation toxicity based on data available. Based on previous encounters, most patients after discussion of risks/benefits pursue mastectomy. If the patient still wanted to pursue BCT, I would discuss with their rheumatologi...
Would you consider adjuvant radiation in a patient with stage 1 (<1 cm) Merkel cell carcinoma of the lateral upper arm status post resection to negative wide margins?
For a stage I Merkel cell carcinoma < 2cm size, long-term outcomes are good and close surveillance may be reasonable, based on the results of meta-analysis. For those with tumors >2 cm or greater, adjuvant RT can help improve loco-regional control and survival. Additionally, ongoing trials of anti-P...
How would you manage an elderly, medically inoperable patient with high-grade, muscle-invasive bladder cancer who has already received definitive prostate irradiation?
The more patients with prostate cancer we treat and the longer they live, the more likely this is to happen. While cystectomy is the right thing to recommend, it is often a very difficult operation as continent diversions are impossible, and the risk of bowel injury is high. If the patient is elderl...
In what settings would you offer adjuvant radiation for a R1 resected desmoid tumor?
We usually avoid RT for margin positive desmoid unless at a location where surgery for recurrence would be hard like deep seated in pelvic region or involving nerve fibres where implication for recuurence in terms of symptomatology is higher
How do you manage patients without a pathologic diagnosis of malignancy referred for palliative radiation?
If there is great certainty that this is malignancy (i.e. cord compression with a large lung mass) and the patient is unwilling to undergo biopsy, this is still an emergent situation and no treatment would lead to loss of function or life. In this case, it's worthwhile to have a consent written up f...
How would you approach treating a patient who refuses surgery, but has significant residual disease after chemoradiotherapy for squamous cell carcinoma of the esophagus?
IO and herceptin/perjeta/enhertu
Can SBRT be considered for high risk prostate cancer?
There are many ways to address this question:1. The academic "letter of the law" purist: "If a patient population was included within a clinical trial then the trial results apply to them. Subset analyses are hypothesis-generating."By this logic: HYPO-RT PC enrolled about 11% high-risk disease and s...