Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What form of surveillance do you recommend for esophageal adenocarcinoma s/p NACRT and resection at what frequency?
We pretty much follow the NCCN guidelines. H&P every 3 months x 2 years, every 4-6 months out to five years, and our thoracic surgeons tend to continue annual follow-up after that. CBC and chemistries at each visit. NCCN points out that the value of CEA is unknown, but we tend to check them. Imaging...
Do you hold immunotherapy when administering lung SBRT?
Good question, limited data to inform an answer.An ongoing trial ("iSABR") in which we are participating involves giving durvalumab 5 days prior to lung SBRT for early stage NSCLC and then continuing that agent for a total of 5 cycles; data are maturing, so I can't offer an estimate of pneumonitis r...
What are your top takeaways in GI Cancers from ASCO 2023?
It was a big year for rectal cancer treatment! PROSPECT (Deb Schrag et al.,) - for selected “high” rectal cancers we can likely omit radiation if they have a good response to FOLFOX. Notable exceptions: tumors that require an APR, are stage T4 or N2. About 10% of patients will not have at least a 20...
When treating a patient with anal cancer with a vaginal dilator, do you routinely simulate the patient with and without the dilator in place?
We only simulate with the dilator.The first point is that most of the benefit of the use of a dilator is in the accurate identification of the vulva / introitus avoidance structure during the contouring and planing process. It provides a separation and a place for the penumbra of the beam to go.We h...
Do you offer memantine for cognitive preservation to glioma patients?
I do not as there is currently no evidence to support this. There was a trial conducted by the RTOG for whole brain RT patients with mets which demonstrated a trend towards improvement in time to cognitive decline (53.8 % at 24 weeks for memantine vs 64.9 % for placebo), executive function at 8 and ...
When do you add chemotherapy to post operative RT for vulvar carcinoma?
We add for node positive disease treated with adjuvant RT especially if it is macromets (either after SNLN or INLND). Gill et al., PMID 25868965
Is dyspnea without radiation pneumonitis a side effect of lung radiation?
Thanks for the interesting question. I would want to know: on what basis are we saying that the patient does not have radiation pneumonitis (RP)? I am going to assume that this is being stated since the imaging findings are underwhelming in this case. Assuming that this is the case, I would answer: ...
How would you design chest wall boost in a patient who underwent mastectomy with a Wise-pattern incision?
Great question. We've all dealt with this scenario clinically. I'll first point out that there is no prospective data for use of chest wall boost in the post-mastectomy setting. The most common location of recurrence following mastectomy is the flap skin, and the most common subsite, but not always,...
What is the appropriate timing for adjuvant radiation for vulvar cancer?
You follow the same principle as other squamous cell cancers to start within 6 weeks for surgery but sometimes are limited by post-op healing. Ashmore et al., PMID 33500149
How would you approach adjuvant systemic therapy for an isolated, oligometastatic CNS recurrence of RCC that was treated with SBRT?
I tend not to treat patients with resected/irradiated CNS lesion(s) if there is no disease elsewhere. Such patients were not included in the adjuvant pembro study, the activity of any systemic therapy for CNS disease is not well-established, and in general, I worry single agent pembro is undertreatm...