Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient who received pelvic radiation 15 years ago and now has a 5 cm colon adenocarcinoma and squamous cell carcinoma of the anorectum?
I think the objective in a retreatment case like this is to maximize the chances of curing cancer with as little RT as possible. I would consider disease free survival with a functioning colostomy a better outcome than survival with an intact rectum but chronic difficult-to-manage complications. I w...
Do your radiation treatment recommendations change if a breast cancer patient does not complete a full course of neoadjuvant chemotherapy?
No. For the usual patient who has operable/resectable breast cancer, who is planned to have induction chemo followed by surgery, failure to complete the induction chemo would not alter my planned RT. Inherent to this question is the related question of: "Should we alter the RT plans based on the res...
Do you recommend adjuvant radiation for a recurrent pT1bN0 vulvar carcinoma?
For recurrence disease, if the depth of invasion is more than 1 mm and nodal assessment is not done then would favor/discuss RT. Data shows with each recurrence, risk of nodal involvement (15%) goes up which is hard to salvage Grootenhuis et al., PMID 26428940.
Would you consider radiation therapy before chemotherapy in a patient with stage I-II high-grade B-cell lymphoma presenting with a large necrotic skin lesion?
I would add that it is important to have a reasonable overall plan with Heme-Onc agreed upon to increase the likelihood of a successful outcome. Ideally, chemotherapy is administered first. This allows "consolidation" RT to be customized based on response. For example, a lower dose is utilized in a ...
How would you treat an essential-like tremor secondary to tumor (e.g. glioma)?
This is a great question. The first step in managing tremor in the setting of a tumor or underlying mass is to first determine the phenomenology. It is not uncommon for dyskinesias like chorea or dystonia to arise after onset of tumor or treatment of tumor. Thus, looking for subtle (or not so subtle...
In which situations do you consider post-mastectomy radiation therapy when the patient has a localized node-positive breast cancer with a complete nodal response and minimal residual disease in the breast post-neoadjuvant chemotherapy?
This is an area of open study as we await the results of NSABP B-51. Off study at this time, I discuss the role of PMRT with all patients, with cN1 patients with a pCR in the nodes. I discuss PMRT is likely to provide a locoregional recurrence benefit, though survival advantage is unclear. Factors t...
Are apocrine type TNBC breast cancers less sensitive to radiation?
Data suggest that behavior is less aggressive with less risk of distant mets than other triple negative cancer but from an RT perspective, treat like any other triple negative cancer.
If blood counts are being checked during concurrent chemoradiation, is there a number at which point you would recommend a radiation treatment break?
I’ll let the platelets go as low as 10K before stopping. I lean heavily on the rate of decline to intervene with a break sooner than the absolute numbers if heading for trouble and later if decline is slow and at reaching the end of treatment.
Would you offer definitive chemoRT for NSCLC with histologically-proven contralateral station 11 nodal involvement?
Contralateral hilar involvement is staged as N3 per AJCC 8th edition. In that regard, the management of an N3 patient should mimic that which we consider for any locally advanced IIIB or IIIC patient. Full staging including brain MRI is necessary. Pulmonary function testing including spirometry and ...
What is the role of CNS prophylaxis in a healthy patient in their 60s with a large DLBCL of the cranium/dura with brain parenchymal invasion?
In general, the role of CNS prophylaxis designed to prevent CNS progression in aggressive B-cell lymphomas is controversial given that it has known toxicities (infections, cytopenias) without good data to support. We still do it at our institution for patients with biologically high-risk tumors, but...