Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient with a superior sulcus tumor of the lung treated with upfront surgery, who achieves negative margins and has negative mediastinal nodes?
The guidelines are unfortunately unhelpful and conventional wisdom may be to consider tri-modality therapy. But, there is room for pause.Let us remember that surgery for superior sulcus tumors was initially deemed futile. That is until Chardack and MacCallum reported the first successful survivor wi...
Would you recommend salvage XRT in a pt who had RP for high risk prostate cancer who then had recurrence in the bladder s/p cystectomy?
Interesting case. I suspect based on the extent of surgery he has undergone in the lower pelvic region there is plenty of scar tissue and sagging intestines in the region now in addition to residual cancer cells based on the + margins. The latter (intestines) will certainly require lower the total d...
How would you treat a patient with adenocarcinoma of the GE junction in the setting of interstitial lung disease?
Protons.
Would you consider consolidative RT in patients with metastatic bladder cancer after near complete response after Keytruda?
Generally, no I wouldn't, as I can't quantify the risk-to-benefit ratio given the paucity of data.
Would you offer adjuvant radiation to the surgical bed for a Merkel cell carcinoma of the upper extremity with low-risk features as per the NCCN Guidelines?
There is no clear role for adjuvant RT here. This is a low risk situation and may be safely observed.
How would you treat a contralateral mastectomy scar recurrence of inflammatory breast cancer?
While uncommon, contralateral recurrences can occur. Once biopsy proven, I would re-stage the patient. I would have a breast surgeon evaluate for resection. If staging is otherwise negative and patient undergoes resection, I would treat adjuvantly with comprehensive RT to chest wall and regional nod...
How do you approach CNS directed therapy in a patient with Parkinson's disease?
I have in the past encountered very few patients with Parkinson’s disease who have required CNS radiotherapy for tumors. The main thing is if the patient has any head tremors at rest (which is rare), extra care for good head immobilization, and perhaps additional target PTV, would then need to be co...
Do you have preferred regimens for young patients (<30 y/o) with early stage DLBCL?
For patients with early-stage, non-bulky disease, 3 cycles of R-CHOP + ISRT (30 Gy) provides excellent outcomes. This strategy is particularly attractive if the site(s) of disease requiring irradiation would engender a very low risk of late effects from RT (e.g., an inguinal lymph node). In the rand...
What is the largest non-spine bone metastasis you would be willing to treat with SBRT?
The size or volume per se is not a limiting factor for SBRT. Doses to OAR (parallel and serial organs) are the most important factor. I have treated large bone metastases with ablative radiotherapy (SBRT or hypofractionated IGRT) without issues.
For breast cancer patients s/p IORT with pathologic features indicating that follow-up whole breast radiation is needed, is the current standard of care to use conventional fractionation or are there data to support hypofractionation?
I have used 40 Gy in 15 fraction, as the equivalent dose is less than 50 Gy in 25 fraction, and thus we don’t expect a significant difference in outcome.