Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a patient who is HIV+ with a p16+ SCC obturator node presumed to be T0N1 anal cancer?
Patients with SCCa unknown primary met to pelvic nodes are highly curable. We published 60% 5Y survival. You almost never find a primary, one almost never presents later without elective treatment. If it does, it is easy to salvage with radiation or surgery. Therefore, I do not recommend elective tr...
When would you consider a workup for C. diff in a patient with diarrhea under-going concurrent chemoradiotherapy for rectal cancer?
Good question – and hard to pinpoint a strict answer. I think any time the diarrhea is out of proportion to expectation (i.e., very early in RT course), clinically significant (dehydration, etc), and not controlled or responding to anti-diarrheal medications, especially in the setting of C. diff ris...
How do you boost patients with IVA cervical cancer who present with a large fistula that worsens during chemoradiation?
Preferred is interstitial brachy with our dose of 5.5 to 6 Gy x 5 in BID fractionation. Either MRI pre brachy with CT-based planning with applicator or MRI-based planning if can use hybrid applicator.
What is your recommended way of managing a locally advanced bulky base of tongue (BOT) p16 negative squamous cell carcinoma extending into multiple structures of the supraglottic larynx?
ChemoRT. We did pretty well with RT prior to HPV. Surgery is likely no better and more morbid.
How long to you wait after laparoscopic oophoropexy to deliver pelvic radiation?
I am not familiar with any data to guide an optimal interval between ovarian transposition and start of pelvic radiotherapy as it relates to impact on ovarian function, toxicity, or other end-point. As continued delays in radiotherapy may be associated with poorer oncologic outcomes, I have tried to...
What is your surveillance strategy in patients with brain metastases who are getting systemic therapy?
Generally, I’d consider a repeat MRI every 2-3 months, earlier if warranted. Assuming no evidence of disease progression for 1 or 2 years, I’d consider every 3-6 months.
How would you approach a vulvar cancer with para-aortic and pelvic nodes?
I have treated a few patients with curative intent if ECOG 0-1. Especially if HPV positive. Below is the link to outcome for anal cancer with pa node involvement.Holliday et al., PMID 29907489
For adjuvant radiation decision making purposes, how is the "Lower Uterine Segment" (LUS) defined?
We have always used the pathologist's description of LUS (fundus, body, LUS, and cervix). That being said, I don’t use LUS as risk factor for deciding adjuvant treatment except in borderline cases where may lean towards brachytherapy if otherwise a candidate for observation.
What are your top takeaways in Breast Cancer from ASCO 2022?
DESTINY-Breast04: it is phase III study of Trastuzumab deruxtecan (T-DXd) vs treatment of physician’s choice in HER2-low metastatic breast cancer (MBC). This study showed improved progression-free survival (PFS) and overall survival (OS) with T-DXd vs standard therapy in this patient population. T-...
What are your top takeaways in GI Cancers from ASCO 2022?
1. DYNAMIC study: I believe circulating tumor DNA (ctDNA) will dramatically improve personalized medicine for cancer patients. This study confirmed that ctDNA-based adjuvant chemo treatment significantly decreases the patients who need/are recommended for adjuvant treatment (50% reduction) without c...