Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For recurrent glioblastoma treated with combined re-irradiation and bevacizumab, how long do you continue bevacizumab?
In the event of recurrent GBM, for example, if i.e. fSRT regimen like 30 Gy/5fx to be used for salvage, would not exceed more than 12 doses (6 cycles) of bevacizumab max. Even in the pseudo-response setting, the toxicity far outweighs the benefit beyond this.
What is the role of radiation therapy for an elderly patient with medullary thyroid cancer who is not a surgical candidate?
We have offered definitive RT for MTC patients who are medically or surgically unresectable. Dosing is variable based on involved structures, performance status, staging, etc. We have used 5400 cGy in 18 fractions, particularly for the more elderly, poor performance status patients. Coverage of elec...
What is the appropriate dose/fractionation when treating a dermatofibrosarcoma protuberans of the spine following debulking surgery in a patient with a good performance status?
Certainly, a challenging circumstance. With DFSP, pathology review is critical to evaluate for transformation to more aggressive variants with higher malignant potential. Clinically, DFSP is usually present for decades and extremely slow growing. Sudden changes in growth rate are concerning for tran...
How do you define your post-operative treatment volumes for a patient with a resected high-grade soft tissue sarcoma of the soft tissues of the upper back?
Thank you for this question. My concern with the lack of pre-surgical imaging is that there is not a good delineation of tumor extent. In scenarios of non-oncologic resection or resection without prior imaging, one should be wary of this. As such, my recommendation would be to be more generous with ...
Can venetoclax and radiation be safely given concurrently?
There is a recent retrospective review by Ho et al which looked at the toxicity profiles associated with "novel" oral lymphoma agents of ibrutinib, venetoclax, and lenalidomide concurrent with radiation treatment for lymphoma, as compared to sequential therapy of novel agent followed by RT (separate...
What dose do you use for single fraction SBRT when treating a small, peripheral early stage NSCLC?
There have been two randomized phase II studies of single fraction versus multi-fraction lung SBRT for medically inoperable early stage lung cancer patients. In RTOG 0915, 82% of patients were T1. In the Roswell Park Cancer Institute study, 86% of patients were stage IA. With that in mind, the curre...
What is the appropriate treatment approach for a primary squamous cell carcinoma of the trachea?
Treating tracheal malignancies is obviously challenging. I typically determine treatment based on the location of the primary. Upper tracheal (above the sternal notch) I treat more like a HN cancer while below that I treat more like a lung cancer. Upper tracheal cancer are more difficult to resect d...
What's your approach to adjuvant therapy for neuroendocrine (small cell) cancer of the parotid gland?
While it is rarely possible for a primary NE cancer to arise in the parotid, the vast majority of these are actually Merkel cell carcinomas (MCC) secondary to a skin primary in the draining zone of the parotid (or pre auricular nodes) in the face/scalp. Even if a primary were to be never detected, w...
What are your treatment volumes for patients with gastric cancer receiving adjuvant chemoRT for a positive margin following gastrectomy and D2 nodal dissection?
INT-0116 remains the only positive phase III trial showing a benefit to adjuvant chemoradiation for gastric cancer. Though very few of those patients had D2 dissections, unplanned subset analyses of 0116 and comparison to a contemporaneous Korean non-randomized trial in patients with D2 dissections ...
How do you approach pre-operative chemoradiation for vulvar cancer?
Over time, the approach shifted from administering preoperative doses to delivering more doses in the mid-60s. Biopsies are now conducted at 8-12 weeks for persistent abnormalities to define pCR and persistent disease, thus enabling tailored management (Richman et al., PMID 32981696).Also this abstr...