Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does consolidation durvalumab increase the risk of pneumonitis in Stage III NSCLC?
Given the heterogeneity of pneumonitis presentation, the presence of pre-checkpoint inhibitor chest/mediastinal irradiation (by definition in this trial), and the other risk factors often seen in this population (COPD/emphysema, current/past smoking history), it is a real challenge to decipher pulmo...
What is the best treatment regimen for a fungating SCCa of the scrotum arising from untreated genital warts invading the groin and base of the penis with bilateral inguinal nodes?
This is a case where I would like to see the patient and the imaging before giving you my opinion. Management in this situation will take a multidisciplinary approach with med onc, urology, and possibly a colorectal surgeon being involved in addition to rad onc. I don’t think there is a single best ...
What RT dose do you recommend for carcinoma in situ of the glottic larynx?
I use 2.25 Gy/fx per the Yamazaki randomized trial (PMID: 16169681), 56.25 Gy to 63 Gy depending on lesion bulk. Sometimes the laryngeal biopsy may not have been deep enough to detect invasion or only a portion of a larger lesion was biopsied, leaving the possibility of invasion remaining. We discus...
When do you consider total neoadjuvant therapy (chemotherapy and chemoradiation) for rectal cancer?
My practice, and that of my group, has moved more towards a TNT model for stage II and III patients, though I think we are all looking for the PROSPECT data to be finalized. NCCN has adopted TNT as a possible consideration, and other groups are considering this more and more (Cercek et al, Jama Onco...
How does the presence of lymphangitic spread in a single lobe impact your management strategy for locally advanced NSCLC?
in my anecdote of n=1 I included the entire lobe as CTV/ITV - chemoRT 60/30 followed by durva. Provided lung constraints are met I would suggest to include entire lobe as is at risk
Would you electively treat the neck for a completely resected parotid carcinoma ex pleomorphic adenoma with negative lymph node sampling?
High grade, yes. Low grade, no.
How would you approach a patient with Gleason 9 prostate cancer and regional lymphadenopathy as well as inguinal lymphadenopathy (M1a) but no bone metastases?
Definitely warrants a balanced discussion. Systemic therapy as the mainstay is definitely the right answer--long-term ADT for sure, at minimum. I think offering to treat the prostate with RT is fair, based on STAMPEDE. For a fit patient with good life expectancy, I would explain to the patient that ...
Do you routinely use bolus for treatment of early stage glottic cancer?
Our group routinely uses IMRT to treat early glottic cancers, with the object of reducing carotid and skin toxicity. As such, we treat the entire larynx with a 5 mm PTV expansion and see good coverage of the anterior commissure in general. We do not add bolus routinely. This might not apply to a ver...
How would you manage prostate cancer with isolated presacral nodal metastasis?
Unfortunately, we can't really use RTOG 0521 to guide us here, as men with involved nodes detected by imaging were excluded. Also, according to the AJCC 8th edition staging manual, pre-sacral nodal involvement would be considered N1 rather than M1a, so although this man is at high risk for subsequen...
Do you have any specific bowel constraints when treating patients with palliative radiation 3000/10?
When treating palliatively with 30 Gy/10 fx, I don't routinely use bowel constraints. In terms of max dose, I look to minimize hot spots but don't use specific volumetric or point doses.