Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach Spine SBRT to 2 separate noncontiguous vertebral bodies ?
I would feel comfortable treating concurrently. But, sequentially is fine, too. The vertebral SBRT RCT allowed for 3 consecutive to be treated, so if non-contiguous, would use the same planning criteria.
Do you continue to obtain dedicated imaging of the spine after palliative radiation for epidural disease or cord compression?
If palliative, I do not routinely get imaging after treatment. The best way to know if it has worked is if the symptoms stabilize or resolve. Imaging is reserved for when a patient has worsening or return of symptoms. If oligometastatic and treating to higher dose/ablating, would consider imaging af...
Would you alter radiation recommendations for a patient with locally advanced rectal cancer and a history of abdominopelvic lymphoma radiation 40 years ago?
In the case of more recent RT, I would get the records in order to inform treatment recommendations. However, records are typically impossible to get in this situation. We have several options here. The first is the avoidance of radiation, as was recently reported in the PROSPECT study. (Schrag et a...
Would you offer post-operative radiation for a T2N0 rectal cancer with less than 12 lymph nodes found in the specimen after LAR?
I would like to know further details of the pathology before making a recommendation regarding post-op RT: location of the tumor - low vs mid vs high rectum, resection margin status, LVSI, EMVI. All these factors can help make a predictive assessment regarding the risk of local recurrence. For mid-...
What definitive dose would you use to treat a recurrent basal cell carcinoma in the oral cavity?
I don’t recall seeing a BCC in the oral cavity. Lips? 66-70 Gy at 2 Gy per fraction.
What is your recommended radiation field in early stage vulvar cancer (T1a-b) with myelosuppression, inconclusive SLNBx, and persistent positive margins?
Would favor vulva and bilateral groin (limit to medial groin to reduce marrow exposure of femoral region).
Would you have any concerns about giving pelvic radiation in someone with a previous history of receipt of HIPEC?
I have done it a few times but important to know pelvic adhesions at the time of surgery to counsel better about the risk of SBO (pros vs. cons).
How would you manage a ER/PR positive, HER2-negative grade 2 T3N0 invasive breast cancer s/p adjuvant chemotherapy who had post-operative complications with reconstruction?
The role of PMRT for pathologic T3N0 cancers remains controversial. However, I would consider PMRT for a woman in her 30s with T3N0 disease with LVSI. In terms of delay, would depend on how long since surgery and if the patient was receiving chemotherapy during that time. Literature has used differe...
Do you resume RT for LS-SCLC after a prolonged break?
Compressing TRT to 3 or 4 weeks minimizes the chance of breaks more prevalent with 6-7 week plans. You cannot make up for lost effectiveness by resuming after break for whatever reason. I do not break for counts.
Would you consider maintenance immunotherapy after cisplatin-gemcitabine chemotherapy and chemoRT for stage 3 bladder cancer in a patient declining cystectomy or who is a poor surgical candidate?
Great question and relevant clinical scenario. We need a clinical trial in this setting, the INSPIRE (EA8185, PI: Dr. @Dr. First Last) is an ideal trial to enroll. In the meantime, would not add "consolidation/maintenance" ICI in the absence of data in this particular setting.