Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there consensus target volume definitions for craniospinal irradiation following resection for adult medulloblastoma?
Craniospinal irradiation (CSI) continues to play an important role in the management of medulloblastoma and other brain tumors that disseminate through the CSF. Because these tumors are more common in the pediatric population, the guidelines adopted for adults are usually adapted from those used in ...
Do you advise Kegels/pelvic floor physical therapy to minimize urinary incontinence when irradiating the prostatic fossa?
I have not recommended Kegels/pelvic floor PT in asymptomatic patients, but if patients are symptomatic either before, during, or after RT, I will make this recommendation. My preference is to refer the patient to a Physical Therapist or pelvic rehab team with special expertise in this field, but if...
Is there a subset of patients with Paget's disease of the breast in whom you would omit radiation after a central lumpectomy?
I would approach treatment following the same principle as low-risk DCIS. If there's no evidence of invasive or underlying DCIS, I would engage in discussions regarding the potential for radiotherapy or observation, with or without anti-estrogen therapy.
For non-metastatic MIBC patients with incomplete debulking TURBT, who are not surgical candidates for cystectomy or repeat TURBT, would you try chemoRT or proceed directly to systemic treatment?
Definitely chemoRT. I believe around 1/3 of patients on BC2001 had biopsy only or incomplete TURBT. No doubt maximal TURBT is preferred, but when it is not possible, that is not a contraindication to definitive treatment. If not a chemo candidate (though there are several options), I would recommend...
How would you best manage a medically inoperable oral cavity squamous cell carcinoma that is locally advanced and node-positive with likely extranodal extension?
Assuming the patient can receive chemotherapy, the expected DFS from standard concurrent chemo-RT is 50% or less. Options to try and improve the prognosis are 1. Higher RT dose than standard, 2. Altered fractionation alone, 3. Altered fractionation concurrent with chemo, 4. Adding cetuximab to concu...
Would you recommend BCS and adjuvant radiation for early stage multicentric breast cancer?
In the era when advanced breast imaging was not available, the data suggests that the risk of IBTR was high with BCS and RT. This could have been because of under assessment of the extent of disease in breast. The limited data in the modern era suggest the risk of IBTR may not be that high (using MR...
What criteria do you use when considering treating the pelvic nodes in a salvage prostatectomy case versus covering only the postoperative bed?
Since we don't have any high-level evidence with which to guide us, this is a question with which I am constantly struggling, too, and frankly, my practice has changed over the years. In general, I will consider irradiating the pelvic nodes in patients with Gleason 8-10 tumors, seminal vesicle invas...
How do you approach treatment of a spinal meningioma?
Surgery is usually the first option. If there is a good resection, the histology is WHO grade 1 (usually) and any residual tumor, if present, does not threaten the spinal cord, one could observe and decide on further action later when the tumor shows signs of growth. If the surgery is only a biopsy ...
Did NRG LU004 demonstrate safety with hypofractionated lung radiation and concurrent ICI?
We reported the initial safety results at ASCO in 2022 after the trial was completed in 2021. There are no DLT signal and safety concerns of combining durvalumab with radiotherapy, whether it is conventionally fractionated or hypofractionated. The manuscript is under preparation incorporating some b...
What is your treatment approach for a pediatric patient with uterine embryonal rhabdomyosarcoma found after removal of a prolapsing uterine mass, with no evidence of distant metastasis on imaging?
Based on the location of the uterus, this would be a favorable site. In the scenario presented, the tumor is noted to be removed, but the margin status is not noted, which could greatly affect the approach. Also, the exact uterine location (such as cervix vs body of the uterus) may make a difference...