Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What follow-up imaging do you recommend after SBRT/SABR for lung cancer?
I generally take a more conservative approach for follow-up. Most guidelines do not recommend, in fact they discourage, routine PET-CT after definitive treatment of lung cancer. Therefore, for pure surveillance purposes I utilize chest CT only. My schedule is every 6 months for 2 years and annually ...
How does the recent publication of RTOG 0813 affect your management of centrally located lung tumors?
RTOG 0813 s a very valuable data set. This was the first trial using the TITER method performed within NRG Oncology (formerly RTOG). When 0813 was written, we fully expected there to be more toxicity events than were actually experienced. Please remember that we did not limit dose to central structu...
Does proximity to or involvement of the aorta effect the dose and fractionation you use for an early stage NSCLC?
In the primary treatment setting I think it's very safe as long as you adhere to the constraints used in RTOG 0813 (105% to 0.03cc) since this would be considered a central tumor. I have never seen a complication from treating the aorta using those constraints in the upfront setting. Retreatment is...
In what situations would you omit craniospinal irradiation in a patient with a pineoblastoma?
I think in general, for pineoblastoma, the treatment paradigm has been for craniospinal radiotherapy due to risk of craniospinal seeding. I would take into account the extent of resection, age, spinal disease, etc.
Can the radiotherapy dose be reduced in patients with head and neck cancer who have a complete response to induction/neoadjuvant chemotherapy?
Agree with Dr. Kimple, and some more comments:While the prognosis of patients with HNC achieving CR after induction chemo is better than of those who do not achieve CR, there is no level III evidence that reducing RT intensity in those achieving CR is safe. Randomized studies of induction followed w...
What is your approach to managing asymptomatic ORN of the mandible?
Do nothing until you have to.
How would you approach potential SBRT to liver metastases in a patient on a VEGF inhibitor?
For patients who are on VEGF inhibitors, I would be very careful with dosing of radiation to nearby bowel and I discuss holding VEGF inhibitors for a time before, during and after radiation. There have been multiple reports of in field toxicity, particularly with respect to bowel (liver SBRT frequen...
What is your preferred treatment for locally advanced poorly differentiated carcinoma of the nasopharynx with bulky neck nodes that is EBER negative and p16 negative?
To date, there is no data as to whether induction chemotherapy followed by chemoradiation vs chemoradiation followed by adjuvant chemotherapy should be administered. Moreover, either option is listed as standard of care treatment by the Head and Neck NCCN guidelines for locally advanced EBV (-), p16...
How would you manage a patient with distal rectal adenocarcinoma involving the anal canal and a single non-bulky inguinal nodal metastasis?
Patients with low rectal cancer and inguinal involvement at presentation should obviously be treated with curative intent because inguinal lymph nodes are first echelon drainage from the low rectum and anal canal. Standard dose neoadjuvant chemoradiation and limited surgical excision of the involved...
How do you manage internal vaginal burning during pelvic radiation?
I would start with a pelvic exam to rule out cuff dehiscence if post-op, easily treated candida infection and STI. If cuff intact, no white plaques or exudates are seen, would consider checking the plan for unintended hot spots that could lead to mucositis if that's noted. If post-operative non-endo...