Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is close observation a reasonable option for elderly patients with a small basal cell carcinoma of the face?
Yes, depending on life expectancy, logistics, and morbidity of treatment which would be minimal with RT.
How are you managing patients with H&N cancers meriting definitive concurrent chemoRT during cisplatin shortages?
If cisplatin cannot be used, other systemic therapies should be considered. The NCCN guidelines list various regimens, as noted below. Given the improvements in the delivery and quality of radiation therapy, I am a believer that single agent carboplatin (AUC 6 Q 3 weeks or AUC 2 Q weekly) can be sub...
Do you offer adjuvant osimertinib to EGFR exon 19 deleted patients with T2N0 NSCLC treated with definitive SBRT?
Given the fairly striking benefit of ADAURA in resected patients, there likely would be a locoregional and distant control and likely survival benefit to this approach but we don't have data to support this. PACIFIC-4 is currently enrolling. Study of durvalumab vs placebo in patients with early stag...
What systemic therapy do you recommend for prostate cancer pelvic nodal recurrence on PSMA PET-CT after prostatectomy and salvage radiation?
If the LNs are not measurable on conventional imaging and can be covered in the radiation fields, then for now I treat as high risk salvage setting. Usually suggest 2 years ADT and radiation. If the LNs cannot be covered in the radiation fields, or are measurable, then would also escalate AR-targete...
What is your local control approach to localized relapse of Ewing sarcoma in a site that was previously unresectable and received definitive radiation?
It depends obviously on some other factors including disease-free interval, the site itself, the dose of radiation received, symptoms, etc... Generally, a combined modality approach is attempted. Second-line chemotherapy with either high-dose ifosfamide, irinotecan/temozolomide, or topotecan/cycloph...
How would you approach a vulvar SCC with extension to the anal sphincter and inguinal nodes, 10 years after definitive chemoRT+brachy for a cervical cancer?
I have treated few in this situation. Limited to treating vulva, anal canal with the inguinal region with boost to GTV to 66 Gy EQ2 dose with concurrent cisplatinum, avoided any prophylactic nodal region including mesorectum or pelvic nodal region.
How do you decide whether to offer partial breast radiation to T2 tumors that are 2-3cm in size?
If otherwise technically suitable with favorable phenotype then do offer APBI.
How would you manage a patient with a prior history of an ER+/PR+ breast cancer s/p mastectomy who develops nodal recurrence 2 years after surgery?
If a candidate for neoadjuvant chemo then chemo first, followed by ALND, and then comprehensive PMRT with nodal boost to all undissected nodes to 60 to 66 Gy based on response and residual nodal size. If not a candidate for chemo then AI with CD4/6 inhibitor for downsizing and similar to above for l...
What is your adjuvant radiation approach for a patient that declines chemotherapy for an occult primary TNBC after ALND only, with 1-2 non-bulky nodes positive, no ENE?
Hypofractionation RT to the breast, undissected axilla, upper IM, and supraclav.
If using protons instead of photons, does the use of protons impact your recommendation for using hypofractionation in breast cancer?
I work at Mayo in Rochester, and we have a busy proton breast practice. We routinely use moderate hypofractionation for non-reconstructed or intact breast patients treated with protons. We also have initiated and enrolled a number of patients on hypofractionation trials with our Arizona colleagues, ...