Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the appropriate time interval to assess treatment response in primary vaginal SCC?
I would favor biopsy before any intervention. If positive, would need surgical salvage (similar principle as cervical cancer).Beaty et al., PMID 34455989 This review gives some biological differences between cervical and other HPV-associated malignancies.
How would you approach a patient with stage I gastric MALT who achieved a complete response to chemoimmunotherapy after only 2 cycles?
Although MALT lymphoma generally responds well to chemo immunotherapy, long-term cure is seldom achieved. For early-stage gastric MALT not suitable for antibiotics or failing to respond to same, radiotherapy alone is the treatment of choice, dose 24 to 30 Gray. I would not alter the radiotherapy pla...
Are there any situations where you would consider neoadjuvant chemoradiation as opposed to chemoimmunotherapy for patients with resectable NSCLC prior to surgical resection?
For most of the last 2 decades, there has been a raging debate about the best perioperative approach for the management of patients with high-risk resectable NSCLC, such as patients for example, with preop documented nodal disease. Clinical studies have not been able to settle the key questions whet...
What are various positioning and treatment techniques you use to help reduce bowel dose?
Prone position IMRT/VMAT I tend to use both concurrently for rectal/anal/some gyn. There is a "myth" that prone position is difficult to reproduce. Studies do not show this, or if there is an effect, it can be mitigated by image guidance. Here is another study showing this.
What criteria does your institution use to indicate patient is ready for PEG tube removal?
The short answer is we typically advise patients that if they can maintain an oral diet (using the tube for flushes only) for 2 weeks and demonstrate no weight loss they are typically ready for tube removal. Our patients though are followed through the course of their treatment by a dietician, and t...
How would you manage a symptomatic marginal zone lymphoma of the base of tongue causing globus sensation also incidentally found to have squamous cell carcinoma in situ?
I would not irradiate a Stage 0 oropharyngeal cancer, much less irradiate the necks electively. But this is not just a CIS (TisN0M0 of the base of tongue) case; this is a very interesting/rare case presentation of what strikes me as a kind of Waldeyer's ring "MALToma" of the lingual tonsils. MALToma...
How do you approach hippocampal sparing RT in the setting of peri-hippocampal metastases?
Not unless there is a reason to do so.
How do you approach the treatment of synchronous primary pancreatic and base of tongue cancers?
There are probably many possible pathways here although none of them are ideal. If the patient has a BRCA 1/2 or PALB2 mutation, or even if not, they could start with Gemcitabine + cisplatin for the pancreas cancer which might have some activity against the base of tongue cancer. If there is a respo...
What dose constraints do you apply to the LAD for lung SBRT?
This is a great question and one that does not yet have a clear answer from SBRT toxicity outcomes data. Practically, I think we start with contouring the nearby coronaries (which is not such an easy task to broadly implement from a workflow standpoint!) and evaluating the low to moderate isodose li...
How would you manage a low risk patient with a negative fusion prostate lesion by biopsy but MRI shows apparent advanced disease?
Assuming that the patient has NCCN low-risk features and MRI findings of EPE (which is the most common situation), I would think about this situation in two different subcategories: (1) active surveillance (AS) is still under consideration, and (2) the patient has decided he would like to proceed wi...