Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your top takeaways in Head & Neck Cancers from ASCO 2022?
In nasopharyngeal cancer, the group from Sun Yat-Sen University presented the results of a non-inferiority, randomized phase III study comparing RT alone vs RT concurrent with cisplatin for intermediate-risk patients (stage II and T3N0M0) (Ma et al., 2022 ASCO Annual Meeting, abstract #6000). They f...
In patients with breast cancer, do you use bolus when boosting a chest wall scar or flap with electrons?
In terms of evidence basis for use/non-use of bolus generally in the setting of post-mastectomy chestwall radiotherapy (not limited to electron boost, noting that the use of post-mastectomy boost at all is a topic worthy of debate), here's what I found when I explored the same question a few years a...
Does omission of PCI influence your decision whether to offer consolidative thoracic radiation in ES-SCLC after chemo + immunotherapy?
This is one of those stories that has evolved over time with our improvements in technology.EORTC 08993 (the Slotman study) demonstrated both an improvement in the rate of symptomatic brain mets at 1 yr from 40% to 15%, and an improvement in 1 yr OS from 13% to 27%. However, a huge caveat here is th...
Why do we tend to boost grade 3 DCIS, but not grade 1 invasive disease?
For the same reason that a surgeon has to re-excise a 1 mm margin in a pure DCIS case, but that same surgeon does not re-excise a 1 mm margin on the DCIS that is associated with an invasive component...because guidelines.
What is your approach to patients with locally recurrent prostate cancer following cryotherapy or HIFU?
Limited data has been published on this subject, however, the best results from a standpoint of disease control and side effect profile have been observed with salvage radiotherapy. In general, our practice has been to treat these patients with definitive radiation to doses of 70-74 Gy. For patients...
In patients with newly diagnosed cervical esophageal cancer with limited metastatic disease, do you treat the primary with chemoradiation?
As systemic therapies for GI cancers have become more effective we are being asked to consider consolidative radiation. In general, radiation in this setting is for palliation only. However, in selected patients with limited M1 disease who have a durable response to systemic chemotherapy and the onl...
Is there evidence to suggest that whole pelvic radiation is immunosuppressive and may lead to worse outcomes in the setting of chemoIO treatment for stage III endometrial cancer?
There is data showing lymphopenia with pelvic RT but no outcome data showing it will have worse outcome with IO. Rather, a GOG study for concurrent chemo RT plus IO shows improvement in outcome in comparison to chemo RT alone leading to approval of the use of pembro for stage III and IVa cervical ca...
How do you sequence treatment for a patient following R2 resection of a large extremity leiomyosarcoma who has small lung nodules concerning for metastatic disease, but not yet biopsy proven?
In general R2 resection is not good news. I would first clarify with the surgeon, the barriers to a re-resection. If re-resection is feasible, then perhaps that should be attempted first. This patient is at high risk for local relapse, which ultimately leads to a poor quality of life. If the lung no...
Would you ever considering de-escalating therapy in any way for women with inflammatory breast cancer who had a complete pathologic response after surgery?
The first two options are reasonable but would not reduce the volume of treatment and would still consider for boost around the scar area even with hypofractionation.
Is there a role for consolidative definitive radiation therapy for metastatic rectal adenocarcinoma with good response to systemic therapy (patient is not symptomatic)?
Yes there definitely is. Patients with colorectal cancer are living much longer with aggressive treatment of metastatic disease and active chemotherapy. "Definitive" CXRT is really a neoadjuvant/palliative dose, 50.4 Gy in 28fx is the standard with 3D CRT. We would expect a 30% cCR and if that happe...