Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient with a prior history of an ER+/PR+ breast cancer s/p mastectomy who develops nodal recurrence 2 years after surgery?
If a candidate for neoadjuvant chemo then chemo first, followed by ALND, and then comprehensive PMRT with nodal boost to all undissected nodes to 60 to 66 Gy based on response and residual nodal size. If not a candidate for chemo then AI with CD4/6 inhibitor for downsizing and similar to above for l...
What is your adjuvant radiation approach for a patient that declines chemotherapy for an occult primary TNBC after ALND only, with 1-2 non-bulky nodes positive, no ENE?
Hypofractionation RT to the breast, undissected axilla, upper IM, and supraclav.
If using protons instead of photons, does the use of protons impact your recommendation for using hypofractionation in breast cancer?
I work at Mayo in Rochester, and we have a busy proton breast practice. We routinely use moderate hypofractionation for non-reconstructed or intact breast patients treated with protons. We also have initiated and enrolled a number of patients on hypofractionation trials with our Arizona colleagues, ...
How would you treat a patient with a low grade Follicular lymphoma and Gleason 6 adenocarcinoma of the prostate?
There are too many unstated particular clinical parameters to provide a specific answer to this question, but general principles are that neither of these malignancies necessarily require intervention. The very long natural history of each condition should guide us. Stage, symptoms, functional statu...
Does the presence of ductal adenocarcinoma change how you risk stratify or treat patients with localized prostate cancer?
Ductal adenocarcinoma (DAC) of the prostate is a distinct, but rare (< 1%) subtype of prostate adenocarcinoma. DAC originates from primary periurethral prostatic ducts or in the peripheral prostatic ducts. Because of its predominantly periurethral location, it may present with hematuria, urgency, an...
Are you treating with the superoxide dismutase mimetic Avasopasem (GC4419) for patients receiving chemoradiation for head & neck cancers?
This drug is not yet FDA-approved. It is currently under review by the FDA. I plan to use it after it is approved.
Do you have a preference between using 2 dose levels (5940/6996) versus 3 dose levels (5700/6300/6996) for NPC, EBV+ and why?
These are unfortunately, questions don't that get studied in our field. For whatever reason, the "low dose" for NPC on the RTOG 0225 study is 59.4 Gy and to have doses "around" that (57 Gy and 63 Gy) doesn't seem to add much value. I have transitioned away from 3 RX's to 2 RX's now for the majority ...
What adjuvant therapy would you recommend for a patient with a sarcomatoid carcinoma of the submandibular gland after R1 resection?
Postop RT
How would you approach an adult patient >50 years old with an intermediate risk extremity T2N0 fusion neg rhabdomyosarcoma who is progressing on neoadjuvant chemotherapy with VAC?
In the event of disease progression on chemotherapy, it would be advisable to re-examine the pathology of the patient to determine whether the patient has pleomorphic rhabdomyosarcoma, which is a subtype of adult rhabdomyosarcoma. If this is the case, treatment should follow the NCCN guideline for h...
Is there a role for radiotherapy to the primary in high volume metastatic prostate cancer with well controlled disease on ADT?
Yes, for some patients. Recent evidence supports an emerging role for prostate RT in the de novo high volume mHSPC population with the goal of preventing serious and symptomatic events from local disease progression. A 2023 update of STAMPEDE arm H demonstrated a significant reduction in the 5-year ...