Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with a mid-esophageal squamous cell carcinoma with tracheal invasion confirmed on bronchoscopy, would you treat with definitive chemo-radiation with curative intent?
I generally start with chemotherapy alone in these patients, usually carbo/taxol for 2-3 months, and then re-evaluate with PET, bronchoscopy, and endoscopy to determine if there is still evidence of transmural invasion into the trachea. Often, if the tumor responds, the tracheal invasion is no longe...
Does receipt of chemoimmunotherapy for LS-SCLC impact your recommendation for PCI?
Historic data showed that the addition of PCI for patients with limited-stage small cell lung cancer showing response after chemoradiotherapy improves overall survival and decreases brain failure rates by about 50%. Recently, the addition of consolidation immunotherapy after concurrent chemoradiothe...
How long after resection for brain metastasis do you wait to request a radiation planning MRI?
This is a good question, and I agree with the sentiments above. I think there are two competing issues here--1) evolution of the cavity and 2) regrowth of microscopic disease.While intuitively, one might think that waiting longer might allow the brain to normalize and the cavity to shrink, our data ...
How do you approach the treatment of LS-SCLC after SBRT for a prior NSCLC in the ipsilateral lung?
You know, it was so rare to see this in the first half of my career, and now I see it a few times a year. It's a testament to the improvements we are seeing in the care of lung cancer patients... they are getting 2nd cancers. Where I am (Mayo), we generally treat it exactly like an SCLC from the per...
Is there a role for quad-shot or similar regimen in a patient with a technically resectable, but medically inoperable colon cancer that is both bleeding and causing a partial obstruction?
I do not use quad shot for the palliation of gastrointestinal tumors. I do not believe in giving doses larger than 3 Gy per fraction because it uses up tolerance, and it's difficult to retreat. My strategy is to be able to treat the patient again after recovery of tolerance in a year. This usually r...
Would you recommend sentinel lymph node biopsy at the time of wide excision for a 3 mm Merkel cell carcinoma of the cheek/lateral canthus?
Unlike melanoma and certainly NMSC, MCC is highly unpredictable in nature, with clinical lesion size having little clinical prognostic value. As such, it appears that SLNB is valuable in many cases for the purposes of prognosis and in determining the need for adjuvant systemic therapy and radiation....
How would the updated results of ECOG 3311 influence your adjuvant RT recommendations for HPV+ OPSCC?
This question refers to this manuscript (Burtness et al., PMID 40493877), which is a 4.5-year follow-up of ECOG E3311.The results broadly mirror those seen in previous reports. The most notable novel finding reported is that among patients with low-risk features (who did not get any adjuvant RT), th...
Is keratosis follicularis (Darier disease) a contraindication to the receipt of PMRT?
Thanks for this interesting question. It prompted me to do a bit of literature search and think about how I'd approach this case.For a postmenopausal patient with ER-negative, PR-negative, HER2-negative (triple-negative) pT2N0(sn) breast cancer and unresectable positive surgical margins after mastec...
What are your institutions' preferences on SBRT vs. histotripsy for treatment of liver metastases?
I'll avoid the institutional political discussion of competing modalities. Like many ablative modalities, there is limited data directly comparing the safety and effectiveness of SBRT. As the new kid on the block, histotripsy has no comparative data that I'm aware of with existing modalities.HistoSo...
What is an acceptable maximum "bridging" dose between SRS/SRT targeted brain metastases in close proximity to one another?
Hi @Dr. First Last, hello from your neighbor in Flint, I hope this helps: I use "Brain Minus GTV" as my normal brain OAR, and to reduce the risk of radiation necrosis/edema, I try to keep it under: V12 at 5 cc or less for single fraction SRS; above that I will fractionate V28.8 at 7 cc or less when ...