Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are you incorporating TTFields into treatment protocols for locally advanced pancreatic cancer based on the PANOVA-3 study?
Most medical and radiation oncologists I have spoken to believe that TTFields offer benefit based on the PANOVA-3 trial and support routine use once it is FDA-approved. One of the outstanding questions relates to the use of definitive radiation therapy, which was not included in either arm, but is a...
Are there patient populations in whom you would consider using both induction chemotherapy and maintenance pembrolizumab for a patient with locally advanced cervical cancer?
Would consider for patients with multiple pelvic and high pa bulky nodes where risk of distant mets is extremely high, with the goal to treat with systemic intent, and if good response and no mets, proceed to definitive chemo-RT.
What dose and fractionation do you utilize for node positive HCC?
First thing to point out is that the evidence for an oligometastatic state for HCC is limited. In general, however, I would still recommend definitive RT for limited hilar or infradiaphragmatic nodal spread. The 2 approaches are: 5 fraction SBRT with dose reduction based on the mean liver dose and ...
In patients with concomitantly diagnosed stage IV DLBCL and gastric MALT lymphoma who have residual gastric MALT after 6 cycles of Pola-R-CHP, would you alter the standard dose/fractionation for ISRT for the gastric MALT lymphoma?
Chemoimmunotherapy, while potentially curable for aggressive non-Hodgkin lymphomas such as DLBCL, is not generally considered a curative treatment for low-grade histologies, such as follicular and marginal zone lymphoma. After completing appropriate therapy for the more aggressive histology (DLBCL),...
What radiation fields would you recommend in a young patient with luminal B histology and ITCs in a single sentinel node?
I would not change the RT field, which could be APBI or whole breast, based on technical and biological factors (presuming this is upfront ITC).
How do you manage chronic radiation laryngeal edema for patients treated with RT for a larynx primary in the past?
I agree with @Dr. First Last's response above. I think it is important to differentiate between laryngeal edema resulting from RT and persisting as a sub-acute toxicity, as opposed to a patient who was treated in the past for larynx cancer and then develops laryngeal edema unexpectedly. In the forme...
When, if at all, would you consider sequential chemotherapy and radiation for locally advanced lung cancer instead of concurrent?
Surprisingly contentious. Concurrent provides slight advantage in those that can take it without interruptions. Sequential is better for marginal performance status, poor support systems, homeless. If locally symptomatic, XRT first, otherwise 2-3 cycles chemo.
How important is the timing of weekly cisplatin in concurrent chemoradiation for definitive treatment of cervical cancer?
Weekly cisplatin in concurrent chemoradiation for cervical cancer serves as a radiosensitizer. Theoretically, it makes most sense for the chemotherapy to overlap as much as possible with the radiation. This is why typically these regimens are started on a Monday, and ideally the dose of cisplatin sh...
What V5 dose constraint best correlates with late lung toxicity following definitive chemo-radiation for lung cancer?
In any radiation plan, improving conformity depends upon spreading the “low dose bath†or the V5. For years, there has been a lot of theoretical concern about spreading the low dose base and a number of retrospective analyses suggesting that the low dose bath might have some impact for the defin...
What is a safe dose to deliver to a gastric bed recurrence adjacent to the duodenal stump post total gastrectomy for gastric carcinoma?
We have published that gastric bleeding occurs commonly with volumes greater than 40cc receiving 50Gy or more, in patients receiving ablative radiation in 15% for large left lobe intrahepatic cholangiocarcinomas. Having a primary liver tumor is probably associated with unrecognized coagulopathy in s...