Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach the use of IMRT/VMAT boost for grossly involved internal mammary nodes in breast cancer patients?
We have to get over this idea that "IMRT/VMAT IS BAD FOR BREAST CANCER" mentality. ASTRO pursued this for nearly a decade, but finally removed from "Choosing Wisely". VMAT/IMRT is a tool like any other tool. It is (usually) as good or as bad as the contouring and treatment planning. In some cases, ...
For pediatric Ewing sarcoma, what is the role of metastatic site consolidation?
The COG protocols recommend that all sites of disease including metastatic sites are addressed with local modality measures (obviously this may not be always feasible, e.g. bone marrow disease). Metastatic sites are usually radiated at the end of treatment after systemic chemotherapy.
Do you recommend carotid ultrasound screening at some point post definitive H&N XRT?
Yes. I start 4 years out from treatment. You don’t have to wait for a trial to prove it is effective and cost effective. You don’t want to wait until you’ve seen your first cured patient die or be seriously incapacitated by a CVA. If there are no other risk factors and/or no significant stenosis I ...
In what situations can short course RT (5 Gy x 5fx) be used instead of chemoRT for rectal cancer?
My take? Preop short course RT is grossly underutilized in the US for locally advanced rectal cancer.Progress is slow but we are getting there; the 2019 version of the NCCN guidelines lists SCRT followed by resection as a standard option for patients w/ T3 or N+ disease as long as the CRM is clear b...
In the setting of recurrent breast cancer localized to the chest wall (no prior RT), do you allow concurrent abemaciclib or Enhertu with post-operative comprehensive chest wall irradiation?
We try to hold off as data on concurrent is very limited and in adjuvant studies, it was done sequentially.
Is there an effective therapy for radiation myelitis?
While unproven for CNS or nervous symptom radiation toxicity, Pentoxifylline plus vitamin E may be beneficial. (Chahal et al., PMID 23132124). I have found it helpful for H&N patients with oropharyngeal soft-tissue necrosis and it is unlikely to be harmful.
Are there clinical features that would lead you to consider combining SBRT + immunotherapy in a high risk early stage NSCLC?
I currently only use SBRT + immunotherapy in medically inoperable, early-stage NSCLC on clinical trial, as it is not yet a standard of care for early-stage disease. There are several randomized phase 3 trials currently testing immunotherapy in this patient population, however. On SWOG/NRG S1914, a p...
How do you approach a young patient with metastatic poorly differentiated thyroid cancer with rhabdoid/non-anaplastic features?
Unfortunately, this patient has a very poor prognosis. Due to the nature of her tumor being poorly differentiated, her disease is more likely than not to be refractory to radioiodine. If her disease in the thyroid and neck has not been addressed, external beam radiation therapy should be offered for...
Can a nonbulky, T1-2 supraglottic larynx cancer near the vocal cords be treated like a glottic tumor?
The supraglottic larynx and the pharynx, unlike the glottic larynx, share similar embryological origins and therefore exhibit analogous lymphatic drainage patterns to levels II and III. Therefore, occult dissemination to regional lymph nodes has to be considered regardless of the characteristics of ...
Do you use nomograms to decide whether to treat pelvic nodes in high-intermediate to high risk prostate cancer?
Rather than using risk estimate, my practice is to treat nodes for all high risk patients unless there is a contraindication. The nodal group I treat is distal common iliac, external, internal iliac, obturator and presacral region. The contouring principal is same for all pelvic malignancies and is ...