Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a threshold platelet count for which you would consider holding RT?
It depends on what site. For head and neck and thoracic malignancies contribution to marrow dose is minimal and myelosuppression is normal nadir effect of chemo so we dont hold RT for low platelets. For pelvic malignancies I usually use threshold of 50K for holding RT and 100K for holding concurrent...
How would you treat an endobronchial NSCLC abutting a hiatal hernia in a patient who is medically inoperable?
Rates of G5 toxicity (hemorrhage primarily) with even 8 fraction SBRT from the HILUS trial are unacceptably high. The hiatal hernia adds another layer of complexity and the increased risk for tox with stereotactic approaches. If the patient can get chemo, I’d favor concurrent conventionally fraction...
In light of the recently published LAP07 trial, what is the role of radiation in unresectable pancreatic cancer?
The recent publication of LAP07 is welcome, as the results have been known since the data were presented at ASCO 2013, and my impression is that the results have already led to a reduction in the use of radiation for locally advanced pancreatic cancer. This may be appropriate, but the results need t...
How do you decide when to offer radiation therapy for pleomorphic lobular carcinoma in situ after lumpectomy?
There is limited data, but it appears pleomorphic LCIS behaves like DCIs presenting as microcars, with increased risk of index site recurrence or progression. Based on this research we tend to treat like high grade DCIS following the same principal.In older studies (NSABP) because e cadh IHC testing...
What CTV margins should be used with early stage favorable Hodgkin's Lymphoma in the illiac chain if they had a complete response on PET after 2 cycles of ABVD?
Involved site radiation therapy (ISRT) is currently the methodology of planning a course of RT for patients with lymphoma. It should be emphasized that ISRT is NOT synonymous with "small" radiation fields. It is a system whereby 3D anatomy is utilized (instead of bony landmarks) to delineate a GTV, ...
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 ...