Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When would you consider local ablative therapy (e.g. SBRT, surgery) for patients with oligometastatic non small cell lung cancer on immunotherapy?
Definitely would treat this exactly as I do for EGFR or ALK-targeted therapy. If the patient is doing well, and most sites of disease continue to be controlled but one is progressing I would consider local ablative therapy. That being said, I just had a patient doing well with a CR on ipi-nivo for ...
What strategies do you employ to mitigate mucositis related pain during the treatment of head and neck cancer?
The bottom line is there is no magic bullet that works well. I start Glutamine a week before and throughout the duration of the treatment. It seems to delay the onset. I use custom made mouth pieces to reduce dental scatter if possible--that will reduce mucositis I start with over the counter analg...
How would you manage treatment of a cervical cancer in a patient unable to tolerate chemotherapy or an HDR boost due to medical commodities?
The first step is to be absolutely certain that brachytherapy is not feasible. In our experience this is extremely rare. The patient should have a thorough medical evaluation and have their medical conditions optimized as much as possible before the decision is made to withhold these standard elemen...
Is it beneficial to use fiducial markers if you are using daily cone-beam CT for prostate localization?
The answer to this question will be self-evident if one ever tries to align the prostate to the CBCT at the linac console. It's tough enough to contour the prostate on a planning CT, and the inferior quality of CBCT images only makes it harder to know where the base or apex are. This latter point ca...
Would you offer PMRT to an ER/PR+, Her-2 negative cT3 tumor treated with neoadjuvant chemotherapy, but with a minimal treatment response?
The data on the risk of local-regional failure and the effect of PMRT on outcome are still too limited and contradictory to be certain of the correct answer. For example, the 10-year risk of LRF in the NSABP series of 95 cT3N0 patients having negative nodes but residual breast disease was 12% (1). H...
Would you recommend PMRT for stage IIA (pT1c pN1a) ER+/HER2- grade 2 IDC in an elderly patient with a single positive non-sentinel lymph node?
Agree, no PMRT reasonable given patient age, lack of LVI, low Oncotype, pre-op US showing no abnormal axillary LAD, small G2 tumor, small LN met, and lack of ENE. That said, I don't think offering PMRT with hypofractionation as suggested above by @Dr. First Last is unreasonable (in fact, though this...
How would you approach the parotid volume for a PET avid intra-parotid node when planning definitive chemo radiation for a locally advanced squamous cell carcinoma of the oropharynx?
Beware Warthin’s tumor! I have a low threshold to biopsy given the quite small (but of course not zero) risk of parotid metastasis in the typical patient.
Would you include interconnecting skin in the radiation volume for a patient with lateral forehead squamous cell carcinoma who will receive radiation to the surgical bed and preauricular lymph nodes?
Yes. It's the interconnecting in-transit lymphatics rather than the skin that is the actual target. Since these are very superficial, an electron field would do the job.
Would you consider palliative radiation for a bone metastasis while patient is on pembrolizumab and axinitib?
If the dose to the hollow organs (in this case, the esophagus) is low, it should be OK to give axitinib (with anti-angiogenetic property) concurrently with RT. If the amount of lung exposed to radiation is small, it should be safe to give pembro (risk of pneumonitis) together. The above comments are...
What is the role of MRI in target delineation of radiation therapy for non-NPC H&N cancers?
I don't think MRI is necessary for most OPCs. I do use MRI in some cases, such as 1) patients being considered for surgery first (to determine if endophytic tumor is better suited for RT), 2) whenever I have clinical concern for perineural spread, and 3) to further assess deep invasion or involvemen...