Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What lung constraint do you use when delivering SBRT for local failure of early stage NSCLC following surgery?
We treat these patients in very similar fashion as a primary early stage NSCLC. Provided that the target volume is well defined, does not directly involve the proximal bronchial tree, and in these post-operative cases does not involve the pulmonary vascular hilum we would typically treat with SBRT. ...
Would you recommend adjuvant radiation to the chest wall and/or regional lymphatics after a resected chest wall recurrence?
Absolutely, would treat chest wall and RNI including IMs in most cases
How would you treat an SCC of the helix of the ear with posterior auricular nerve involvement s/p surgical resection?
MR to look for PNI. Likely negative if asymptomatic. CT to look for nodes. Postop RT depends on symptoms and MR and CT findings. If N0, electively treat nodes.
Is there a risk of severe radiation toxicity for a patient with paraneoplastic dermatomyositis due to lung cancer?
One of the treatments for paraneoplastic dermatomyositis is treatment of underlying malignancy which can lead to remission of dermatomyositis in some. I would treat with definitive intent with RT and a few pts I have treated have had improvement of their symptoms with regression of cancer
How would you sequence SRS for brain metastases for a patient receiving dual immunotherapies?
To be honest the strategy in this regard at our center has been haphazard at best. I have not seen any adverse effects that could be clearly related to concurrence of combination dual immunotherapy therapy and GK SRS.My colleague Marc Ernstoff reported results of the Checkmate study which clearly po...
Would you include any elective nodal stations for cases of T3/T4 node-negative NSCLC staged by PET/CT in which a patient cannot undergo nodal sampling?
In short, my answer is “noâ€. I do not target elective lymph nodes for NSCLC patients receiving definitive RT. There are now a few RCTs for locally advanced NSCLC indicating that elective nodal irradiation can be omitted from concurrent chemoradiotherapy (Yuan et al [PMID 17551299], Nestle et al ...
Would you initiate radiation before chemotherapy for the treatment of early stage breast cancer?
The data doesn’t suggest difference in outcome based on sequence but by convention chemo is done before RT. That being said, if for logistical reasons it helps to do RT before chemo then I would do RT before chemo
How would you treat an early-stage gastric adenocarcinoma in a patient who is medically inoperable and not fit enough for chemotherapy?
In my n=1 experience, I treated a medically inoperable patient with a T1N0M0 gastric body adenocarcinoma with "definitive" RT with mild Xeloda. I had the gastroenterologist place clips around the tumor. I treated the whole empty stomach and lymphatics to 45Gy and the gross disease to 54Gy. The patie...
How do you define close and negative margins for soft tissue sarcoma?
The paper by Gundel et al, “Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resectionâ€, J Clin Oncol, 2018 provides useful data regarding the predictive power of different margin classification systems for extremity and truncal soft ...
How do you manage unresctable thoracic esophageal cancer invading the trachea?
I treat these cancers with chemoradiation therapy. That is, I don't forego treatment for fear of creating a fistula where there wasn't one before. Stabilization of the airway is important and should be established before starting treatment and reassessed throughout. If there is a pre-existing fistul...