Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer EBRT for an unresectable and growing substernal goiter compressing the trachea, esophagus, and aorta that has been refractory to RAI?
I know of no data demonstrating that XRT will affect any local control for this benign process; this patient requires a surgical consultation.
In a breast cancer patient treated with neoadjuvant endocrine therapy, how would the presence of a lymph node micrometastasis influence your recommendations regarding radiation therapy?
Data free zone but that being said, since the likelihood of PCR is low (not like triple negative or HER2 negative), I usually don’t necessarily add RNI. For BCT, treat with tangent including level 1 and 2 nodes. For mastectomy, look at other risk factors (pre and post ET) to see if would offer PMRT.
Would you treat comprehensive nodes in an ER+/PR+/HER2+ breast cancer with an initial biopsied node showing atypia and then pCR (0/2 SLN) on lumpectomy?
These are challenging cases. I will ask the pathologist if there is any sign of treatment effect in the nodes. If there is, I will treat comprehensively.If no treatment effect, I will discuss the pros/cons with the patient. I do offer and consider given that MA20 showed modest increases in toxicity ...
Would you offer post-lumpectomy RT in a young adult with DCIS, who received bilateral whole lung radiation for Wilms Tumor as a child?
I think it is difficult to make an absolute pronouncement as to whether one would or would not offer radiation therapy in this particular circumstance. How young is the individual? What dose did they receive for the bilateral whole lung radiation? How long ago was the radiation delivered? What is th...
Would you offer definitive local therapy to a patient with ER/PR+, Her2 neg breast cancer with oligometastatic disease that responded well to CDK 4/6 inhibitor +AI, despite NRG-BR002 results?
The description of "ER/PR positive HER2 negative right breast cancer with a synchronous single site of oligo-metastatic disease in the right 4th rib (near primary tumor but not clearly direct extension) and good response to 6 months of AI+CDK4i" suggests that the primary breast cancer is intact. The...
Would you give palliative breast RT to a patient receiving weekly paclitaxel for rapidly progressing metastatic disease?
Given symptomatic disease and need for palliation, I would treat. I would offer 30 Gy/10 fractions. If localized lesion, I would target this with mini-tangents, limiting dose to lung, given concurrent paclitaxel. If involving skin, I would bolus daily.
How would you reconcile EQD2 calculation for organs at risk in patients receiving BID fractionation to the chest after an initial course of daily conventional fractionation?
There is a paper regarding time-based corrections to BED for hyperfractionation in such a scenario. You end up multiplying the usual result by a time factor that increases the BED above the usual daily fraction result. I don't have the reference handy but it is out there. Maybe someone else on this ...
How do you manage dyschezia and tenesmus following TNT with short course RT?
Specifically for the management of moderate to severe tenesmus and pelvic pain/cramping, I’ve found that combinations of steroids, bentyl, and gabapentin are very effective. Another consideration, if sequencing short course RT prior to chemotherapy, is to delay chemotherapy for 2-4 weeks after short...
In a patient with both Stage III NSCLC and another concurrent high risk malignancy, how do you sequence consolidation durvalumab with local therapy for the concurrent cancer?
I pretty frequently see either 1) concurrent LA-HNSCC and stage III lung, or 2) concurrent stage III and stage I NSCLCs. I wouldn't pause or delay the durva in either scenario. Quite a bit of literature now supporting the safety of concurrent RT (even high dose per fraction/SBRT) and immune checkpoi...
What skin care regimen do you prefer during radiation for patients with inflammatory breast cancer?
The treatment of acute skin reactions is historically a morass, with most centers and physicians (including ourselves) doing different things based on limited evidence and lots of hoary mythology. The myth that most bothers me is patients being told not to use moisturizers before treatment. A phanto...