Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Given results of the RADICALS trials, is LT-ADT standard of care for salvage prostate RT?
I do not think long-term ADT is established as standard of care for salvage prostate radiation, as this would require a demonstration of improved overall survival in at least specific subgroups of patients. RADICALS-HD demonstrates improvement in freedom from metastasis as well as freedom from non-p...
Are you altering your use of Active Breathing Coordination for breath hold technique patients in light of the COVID-19 pandemic?
We use DIBH, and this has not changed anything in our practice.
How would you approach post-op radiation recommendations in patient who had neoadjuvant chemotherapy for locally advanced oral cavity cancers (oral tongue) who have a complete pathologic response (pCR) after surgical resection?
While randomized studies of induction chemo followed by local therapy compared with local therapy alone in the 90’s were all negative, it was clear that responding patients did better than non-responding ones. An example is a study (Licitra et al., PMID 12525526) of quite advanced oral ca randomized...
How would you manage a young patient with Sjogrens disease with extranodal marginal zone lymphoma involving bilateral parotid glands with bilateral cervical lymphadenopathy?
For patients with low-grade NHLs (e.g., follicular lymphoma, marginal zone lymphoma), staging dictates treatment. If a patient has a localized process (e.g., contiguous stage I-II disease), then a definitive course of RT is typically recommended. The conventional approach is 24-30 Gy, though a dose-...
What do you view as the optimal use and timing of cemiplimab in high risk CSCC?
Increasingly, neoadjuvant cemiplimab has become our preferred approach for many patients with resectable high-risk CSCC, and this is consistent with what several high-volume centers are now doing. The high pathologic response rates, durable recurrence-free survival in responders, and meaningful surg...
What if any, is your radiation approach to treating hepatic metastases abutting/invading luminal GI structures?
My approach to hepatic metastases abutting luminal GI structures is fundamentally conservative. When liver metastases abut or threaten invasion of the stomach, duodenum, or bowel, I do not treat this as a classic SBRT scenario. The priority shifts from local ablation to durable local control and pre...
Would you continue cemiplimab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma treated with downstaging immunotherapy?
This is a challenging question because, as you know, we have no randomized data to address it. I generally do not continue immune checkpoint therapy after resection of SCC skin. However, given the adjuvant data in melanoma and the high efficacy of anti-PD1 in skin SCC, I do think it is reasonable to...
Could patients with smIPI > 1 and poor tolerability to RCHOP be offered ISRT after 3 cycles of RCHOP if interim PET showed 5-PS 1-3 response?
The FLYER and LYSA/GOELAMS studies have significantly influenced the management of DLBCL. Although the studies were quite different, they both demonstrated that patients with non-bulky, stage I-II DLBCL and a favorable IPI do very well with 4 cycles of R-CHOP alone. For patients with 0 or 1 stage-mo...
Do you treat synchronous bilateral breast cancers with RT simultaneously or sequentially?
We see a fair number of synchronous bilateral cases here. I am not aware of any compelling arguments or data for sequential treatment over simultaneous. Simultaneous is more efficient in terms of overall length of time, and allows for better coordination of the fields (but there is more time on the ...
How do you manage moist desquamation when treating vulvar cancer?
My experience is largely limited to the treatment of gynecologic malignancies, with the treatment of vulvar lesions the most common reason for development of moist desquamation. The first goal, in my opinion, is to prevent development of moist desquamation as much as possible. Skin folds that are no...