Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can you safely proceed with breast irradiation during treatment with immunotherapy?
In KEYNOTE-522, RT was done with concurrent Pembro after NACT plus IO and no significant additional untoward effect was reported. So, we do RT routinely with Pembro for these patients.
Would you offer salvage radiation for a local recurrence of prostate cancer that was initially treated with SBRT?
At this time, I’m not sure there is enough data to recommend a course of re-irradiation after primary SBRT outside of a clinical trial, although I do know some who offer it. The majority of the data regarding re-irradiation for local recurrence after RT comes from smaller retrospective reports, alth...
Is it time to re-evaluate the timing of radiation and chemotherapy with the adoption of hypofractionated courses of radiation for breast cancer?
Clinicians began treating patients commonly with both RT and chemotherapy (CT) in the 1970s and 1980s. They tried many approaches, including giving RT first; giving all CT first; giving a "sandwich" of several cycles of CT, then RT, then completing CT; and giving concurrent RT and CT, with RT starte...
In light of PORTEC-3 and GOG 249 data, do you use adjuvant radiation therapy alone in stage Ib serous endometrial carcinoma?
The answer is still not clear but these studies do suggest limited impact of chemotherapy in early stage adverse pathology endometrial cancer. The confounding factor is that these studies combined clear cell and UPSC together and which diluted the power of the study. Chemosensitivity of CC is not sa...
Would you recommend a simultaneous integrated boost with hypofractionated whole breast radiation?
With the presentation of IMPORT HIGH trial (CRUK/06/003) at SABCS last month, the data for simultaneous integrated boost SIB in breast cancer is accumulating. This was a phase III trial that randomized 2,617 women to a sequential boost (50Gy +16Gy), SIB arm (40Gy to breast with 48 Gy to boost volume...
Do you try to incorporate mFOLFIRINOX in total neoadjuvant therapy for rectal cancer?
PRODIGE 23 study is an open-label, randomized phase 3 study (Conroy et al., PMID 33862000). Locally advanced rectal cancer patients (cT3 or cT4 M0) were randomized to either the study arm (mFOLFIRINOX X 3 months, chemoradiation, TME, FOLFOX X 3 months) or the standard arm (chemoradiation followed by...
For multiple myeloma, is 8 Gy in 1 fraction an appropriate palliative dose, although this histology was excluded from trials examining a single fraction?
There was a randomized trial comparing 8 Gy/1 fx vs 30 Gy/10 fx for patients with multiple myeloma. There was no difference in analgesic response or recalcification, however patients with the protracted regimen seemed to have a benefit in terms of QOL. However, the the control arm (30 Gy in 10), th...
Would you recommend stent placement upfront in a patient with cervical esophageal cancer and a TE fistula?
Malignant TE fistula is a complex problem which is often associated with a poor prognosis. Palliation with stenting can be problematic as the stent can erode and make the fistula larger. This is especially problematic with "kissing" stents in both the esophagus and the airway and/or in the setting o...
Do you routinely cover level IA lymph nodes for advanced BOT tumors extending into floor of mouth or oral tongue?
Generally speaking, I would cover any draining nodal region that is at risk based upon the involved mucosal subsite(s). If IA is at risk because of anterior oral cavity disease involvement, I would not omit coverage simply for the fact that the primary originated in another location.
Is there evidence to support partial breast irradiation with daily fractionation?
As I understand it, the BID fractionation (e.g. 340 BID) that was used in the early APBI studies were largely for patient convenience. There is a potential anti-cancer benefit as well due to less repopulation during RT, but one would suspect that this is not a big effect since these breast cancers a...