Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer re-irradiation for a prostate local recurrence after I-125 seed implant >10 years ago in a healthy young patient with life expectancy >15 years?
As advanced imaging has helped us better identify patients with local-only disease recurrence, the question of local therapies after prior radiation looms larger. ASCO GU 2024 had an excellent panel discussing surgical, focal, and radiation options for recurrences. Minor self-promotion, but I also t...
Does lymphovascular invasion trump POLE mutation in early-stage uterine cancer adjuvant therapy decisions?
In the current ESGO guidelines, stage I and II POLE types are always low risk, irrespective of substantial LVSI, with a predicted risk of recurrence being less than 10 percent, and favoring observation. That being said, in practice, I do offer brachytherapy, as I feel it is a low morbidity procedure...
Would you offer cisplatin concurrent with radiation to a patient with p53-mutated stage III endometrial cancer if she has adult-onset hearing loss and uses a cochlear implant?
Cisplatin is commonly used for radiosensitization in patients being treated for gynecologic cancer. Ototoxicity is a common side effect of cisplatin. It is caused by the death of outer hair cells in the inner ear. Cochlear implants are used to treat hearing loss in patients with severe hearing loss ...
How do you modify the management of an SLE patient with active systemic lupus for a gynecological cancer that normally requires pelvic radiation and brachytherapy?
I have not done any specific modification for SLE. I would treat with VMAT and IGRT with a 5 mm PTV margin and ensure EBRT and HDR meet ideal dose constraints for OARs.
How would you treat a small cell carcinoma with a 4 cm right Bartholin's gland primary and a single small right inguinal adenopathy?
It’s like limited-stage SCLC would be treated with cis plus etoposide and RT (60-66 Gy). Will favor no elective pelvic node RT if pure small cell carcinoma and no mixed component.
Do you recommend prostate RT for patients with metastatic (M1) disease?
My short answer to this provocative question is “no, I don’t offer men with M1 disease local radiation unless there’s a palliative need.” Treating the primary in the asymptomatic M1 scenario, whether with RT or with surgery, is a major commitment of time, resources, and risk to the patient. The leve...
Should we consider radiation therapy for patients with N2 EGFRm NSCLC who will receive osimertinib, though RT was excluded on ADAURA?
For an EGFR-mutant N2 disease, we favor adjuvant chemotherapy (OS benefit) and/or adjuvant TKI based on ADAURA trial (DFS survival). The only prospective data regarding the use of adjuvant radiotherapy comes from a phase III trial, Lung Adjuvant Radiotherapy Trial (Lung-ART), where patients were ran...
How long after surgery would you no longer offer PMRT for a patient who had pCR after neoadjuvant chemotherapy for stage IIB HER2+ breast cancer?
The value of PMRT in HER-2 positive stage II breast cancer with pCR is debatable, to begin with, and now with 6 months or more delay, I would favor no RT.
What treatments, after appropriate dose reductions/delays, do you offer for patients with oxaliplatin-induced cold allodynia/dysesthesia?
The primary treatments that I use for cold-induced oxaliplatin neurotoxicity are reducing the oxaliplatin dose and limiting the duration of oxaliplatin treatment (usually not more than 16 weeks of oxaliplatin-containing therapy in the initial line of treatment). Medications that are effective for pa...
How would you counsel a patient concerned about receiving IMRT rather than IMPT for oropharyngeal cancer?
I would tell the patient there is absolutely no concern at all with IMRT, and it is a very well-established SOC. I am personally unclear about the OS benefit with IMPT, as it was pointed out, unexpected. It is unusual to see no difference in PFS and no tox difference, and yet there is an OS differen...