Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you consider is too late after resection to offer adjuvant therapy for high grade osteosarcoma?
Regarding the time to resume chemotherapy post resection in osteosarcomas, I do not feel there is a strict cut-off time frame that would render one unlikely to benefit, however, there is well cited literature that shows that a delay of >21 days (3 weeks) leads to a higher risk of death (57%) compar...
Do you ever start immunotherapy along with WBRT in patients with PDL1 >50% metastatic NSCLC with significant visceral tumor burden in addition to symptomatic brain mets?
The general rule in the era of chemotherapy has been to hold concurrent therapy in the context of palliative radiation--in particular whole brain radiation--due to added side effects. These principles have shifted to some extent in the context of targeted therapies and checkpoint inhibitors as exper...
Is superficial underdosing of hypofractionated breast RT acceptable in patients with a large breast separation?
The 3D dose distribution and DVHs should be carefully reviewed for target volume coverage, particularly if the lumpectomy bed PTV is superficial. The most important consideration is adequate coverage (>/=95%) of the tissue included in the region of the lumpectomy bed PTV. Whole breast PTV coverage i...
What imaging schedule do you use for patients with SCLC who choose surveillance over immediate PCI?
In extensive stage patients that undergo surveillance rather than PCI, I've been using the follow up schedule that the Japanese PCI trial (www.ncbi.nlm.nih.gov/pubmed/28343976) used which was q3 month MRI for a year, then q6 month MRI up to year 2.
In the setting of head and neck cancer, if the pathology report shows extranodal extension (ECE), but the location of the node is uncertain, how do you define your boost volume?
It is important to discuss the case with the surgeon and your pathologist to get their input regarding the size and possible location of the node with ECE within the specimen. Ideally, every surgeon that's performing a neck dissection for possible cancer will orient the specimen and divide it into t...
For patients demonstrating ypN1 disease on SLNB following neoadjuvant chemotherapy, is it reasonable to proceed with regional RT in lieu of AxLND outside of the ALLIANCE A011202 trial?
Ideally these patients should go on the Alliance A011202 trial or have a full dissection as the current standard. AMAROS and other studies clearly have shown that radiation to the axilla is highly effective compared to axillary dissection for patients with a positive sentinel node at initial diagnos...
For a MALT of the eyelid, do you treat the entire conjunctiva reflection as well, or just the eyelid?
can you clarify the question? Is the question whether to treat superior and inferior conjunctiva (eyelids) or whether to treat deeper and more laterally on either the sup or inf Eyelid?
Is pectoralis muscle invasion an indication for post-mastectomy radiation (PMRT) for an otherwise early stage, node negative breast cancer with clear margins?
In and of itself no. Given the inclusion of specific node negative patients in MA.20 and EORTC 22922 and small but significant DFS benefit in both, by extrapolation to mastectomy it behooves us to consider carefully the potential benefit of PMRT in node negative patients without over-treating. In re...
For localized esophageal cancer in patients with preexisting neuropathy, what do you use concurrently with radiation therapy?
I would probably start with low-dose carboplatin and paclitaxel as done in the CROSS trial, and monitor carefully for worsening neuropathy with weekly assessment. As the doses are low and the duration of therapy limited to only 5 weeks, we may not see much worsening. In CROSS, there was 15% neurotox...
How would you treat a patient with recurrent brain mets from small cell lung cancer who has already received previous whole brain radiotherapy (30 Gy in 10fx)?
We tend to treat these patients with stereotactic radiosurgery and will treat up to 10 lesions given prior whole brain radiation therapy. We know from studies, however, that despite radiosurgery, they tend to recur elsewhere in the brain and that the need for future SRS salvage is higher than with o...