Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does your treatment approach for NK/T cell lymphoma of the nasal cavity differ depending on the volume and extent of disease?
There has been a recent (2021), updated review of treatment guidelines published by ILROG which provides very detailed recommendations including some considerations about systemic therapy. Qi et al., PMID 33581262.They offer treatment field suggestions based on the anatomic location of the tumor, di...
What is the appropriate treatment for a low lying rectal cancer in the setting of prior definitive prostate IMRT?
As is true for most complicated clinical situations, there is not any absolute answer to this question.First, it does allow me to remind everyone that prostate radiation therapy increases the incidence of subsequent rectal cancer- probably about 2 fold. This shouldn't surprise anyone, but it is some...
How would you manage sarcomatoid carcinoma of the prostate with poorly differentiated adenocarcinoma that is not amenable to surgery?
There is data on this rare histologic variant, albeit limited, and often in these situations we try to extrapolate from analogous areas with more data.It is believed that the pathogenesis of these tumors, the epithelial and sarcomatoid components, arise from a single cell of origin, rather than sepa...
Would you re-irradiate a spleen with increasing splenomegaly for a patient with myelofibrosis?
Would you care to elaborate a bit more on why such a dose was chosen during the prior treatment and what the result was? Other than that, I would re-irradiate, however with a low dose, starting with fractions of 0.5-1.0 Gy every other day, and giving the spleen some time to shrink.
How would you approach an in-field recurrence after lung SBRT for a T1 NSCLC in a patient with poor underlying lung function?
Explore non-radiation options, including any molecular testing to seek potential targeted systemic options. Still exhaust alternative local options such as cryoablation or local/wedge resection. Radiation option can still be considered if all other options are exhausted, considering the location (ce...
Is SBRT an option for a paravertebral lung cancer with vertebral body and rib invasion for patients who are not chemo candidates?
I do believe SBRT is an option for paravertebral lung cancer with VB and rib invasion. My rationale is that SBRT offers improved local control and cancer outcome compared to conventionally fractionated radiation - and that while there may be potential for increased toxicity of treatment in this scen...
Would you consider induction chemotherapy prior to starting chemoradiation therapy in squamous cell carcinoma of the esophagus?
Time and again, studies have shown that induction therapy for squamous cell carcinoma, seemingly regardless of primary tumor origin, probably does not improve the outcomes for patients compared to upfront chemoradiation therapy. For example in Head & Neck squamous cell cancers, the use of induction ...
Would you avoid radiation in a patient with breast cancer with active skin lupus?
In a patient with active skin lupus, I would counsel regarding the risks of radiation toxicity based on data available. Based on previous encounters, most patients after discussion of risks/benefits pursue mastectomy. If the patient still wanted to pursue BCT, I would discuss with their rheumatologi...
Would you consider adjuvant radiation in a patient with stage 1 (<1 cm) Merkel cell carcinoma of the lateral upper arm status post resection to negative wide margins?
For a stage I Merkel cell carcinoma < 2cm size, long-term outcomes are good and close surveillance may be reasonable, based on the results of meta-analysis. For those with tumors >2 cm or greater, adjuvant RT can help improve loco-regional control and survival. Additionally, ongoing trials of anti-P...
How would you manage an elderly, medically inoperable patient with high-grade, muscle-invasive bladder cancer who has already received definitive prostate irradiation?
The more patients with prostate cancer we treat and the longer they live, the more likely this is to happen. While cystectomy is the right thing to recommend, it is often a very difficult operation as continent diversions are impossible, and the risk of bowel injury is high. If the patient is elderl...