Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For patients with clinically node-positive prostate cancer, would you consider adding a brachytherapy boost to external beam radiation and ADT?
Absolutely not. Unless on a clinical trial.Not only are these patients excluded from every brachy trial, there is essentially zero retrospective data. Thus you have essentially no data that this will help the patient. However, what you know is that it will increase cost and increase toxicity.ASCENDE...
Would you modify your treatment approach for treating an HPV-positive head and neck cancer in a patient with symptomatic Sjogren's?
Patients with Sjögren’s syndrome have baseline xerostomia of variable severity. Management of Head and Neck cancer in this population depends on the location and stage of the primary. I would prefer to treat them with primary surgery if at all possible. If RT is necessary either as primary modality ...
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...