Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For a patient who previously underwent PBI and then developed a second ipsilateral primary, would you offer repeat PBI?
If this is a younger patient, I would confirm that they have negative genetic testing before considering re-irradiation, and, in any case, ideally, the management options would be discussed with the patient and surgeon prior to offering breast conservation surgery. Considerations would be the locati...
Would you give adjuvant radiation after complete resection of a small primary cutaneous follicular lymphoma of the scalp?
Not a lot of data, but here goes. First, one has to go back decades in the literature to find series of patients with lymphoma rx'd with surgical resection alone. In general addition of RT improved outcome even when ostensibly resected with neg margins. With today's technology risk of additional RT ...
Is it appropriate to use bolus with hypofractionated PMRT?
Bolus is being used less and less. Most people would only use if T4 disease or if they had a positive margin or some other high-risk factor for skin/superficial recurrence. The indication for bolus would not change based on fractionation. If there was an indication to bolus with conventional, then y...
Would you consider APBI in a patient who meets all criteria but has high-risk genomic testing and is not receiving chemotherapy?
I would proceed with APBI 30 in 5 as it has a boost dose built in to account for a high genomic score.
Should other treatment options be considered for MALT lymphoma if the lacrimal gland will be included in the radiation field in a patient with Sjögren's disease?
The orbit is the second most common site of origin for extranodal marginal zone lymphoma (MZL). Involved orbital structures include the bulbar and/or palpebral conjunctiva, lacrimal gland, and periorbital soft tissues. Patients with Sjögren’s syndrome (SS) are at increased risk for developing extran...
What criteria would you consider to select patients for 20 Gy consolidative RT in DLBCL/HGBL?
The primary endpoint of the study was 5-year local control. The study was powered to estimate this endpoint after the last patient had at least 2 years of potential follow-up (which will be reported at ASTRO). Local failures after 2 years are uncommon. The estimated 5-year freedom from local recurre...
Does the choice of radiation modality (3D, IMRT/VMAT, protons) impact the effectiveness of the reduced dose of 20 Gy in DLBCL?
I don’t think modality (IMRT vs 3D vs protons) has an impact on the effectiveness of the reduced dose of RT.
For biopsy proven extranodal marginal zone lymphoma involving two small bilateral lung nodules, would you consider definitive treatment to both nodules with radiation therapy?
It has been observed that many patients treated with radiation therapy for an extranodal MZL in a paired organ (orbital and parotid, in particular) will develop metachronous disease recurrence in the contralateral organ (Goda et al., PMID 20564130). In fact, it is relatively common for patients with...
For stage III-IV Hodgkin's lymphoma, would you consider consolidative radiation for bulky disease after a complete response was seen using N-AVD per the S1826 trial?
I would offer consolidative radiation only for PET-positive residual disease.
Would you include the supraclavicular basin in adjuvant radiation treatment fields if there were multiple positive axillary sentinel lymph nodes with ECE discovered at the time of resection of a proximal arm cutaneous SCC?
Short answer, I wouldn't. I'd do good restaging (PET vs contrasted CT or both) and ensure you're just dealing with microscopic residual or to guide boosting to gross disease dose if gross residual in axilla, and just treat your involved axilla and primary site if indicated. This is a patient who wou...