Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What would be the recommended management for patients with rectal adenocarcinoma with rectovaginal fistula at presentation?
Diverting colostomy, preop RT chemo, and surgery.
How would you approach therapy in a young adult with synovial sarcoma of the head and neck who is not amenable to surgery due to location on the face?
I do not think primary synovial sarcoma is curable without surgery. I have never seen a durable response in a tumor treated with radiation alone. Synovial sarcoma responds to ifosfamide based chemotherapy generally, but in my experience, the response rates for primary tumors are lower than response ...
Would the diagnosis of skin-only morphea (localized scleroderma) alter treatment recommendations for localized anal cancer?
There is enough data about the acute and late toxicity from radiation in these patients to be concerned. However, none of it rises to the level of the toxicity of APR. Therefore, my approach would be to involve the patient in the decision, document, and reduce the dose by 10%.
How would you approach palliation of a symptomatic cervical cancer involving the supraclavicular lymph nodes?
Bx- to confirm. I would favor chemo first and if responds to chemo, plan for more definitive dose of RT and if no response, then palliative RT.
What is the role of RT for a patient with double-hit DLBCL and a single site of relapse who can no longer tolerate chemotherapy?
Double-hit DLBCL, now referred to by the WHO as "High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements" is an aggressive non-Hodgkin lymphoma. The MYC rearrangement results in accelerated growth of the lymphoma while a BCL2 rearrangement (more common than BCL6) results in an anti-a...
Would you offer preoperative radiation therapy when treating retroperitoneal sarcomas?
STRASS is a landmark trial and the authors deserve warm congratulations for completing a study of this scale in a rare disease. Its results are very important, but they also must be analyzed thoughtfully and taken in context.Several initial points: The primary endpoint was abdominal recurrence-free ...
Are there any special radiotherapy considerations for women who have double lumpectomy?
Z11102 looked at multiple ipsilateral breast cancers and lumpectomies. For these cases, I would be fine with hypofractionated WBI. Boost would be based on features of each cancer so if it was otherwise low risk for both, I would omit boost vs. if both were higher risk (< 50, ER-), I would boost both...
In the setting of adjuvant treatment for locally advanced oral cavity cancer, would you offer altered/hypofractionated courses for elderly patients with lower functional status?
At our institution, elderly patients with locally advanced oral cavity cancers who are treated with curative intent oncological resection are typically also treated with curative intent conventionally fractionated adjuvant radiation based on pathological risk factors. For elderly patients with lower...
How would you manage gastrointestinal bleeding after radiation therapy for pancreas cancer?
In our ablative RT experience (100Gy BED, Reyngold, JAMAOncology, in press), we have had a 2.6% rate of bleeding possibly related to RT in patients not on anticoagulation and 15% in patients are on anticoagulation. Using the point dose constraints (60Gy in 25# and 45Gy in 15#), we have typically see...
When do you recommend prophylactic treatment of spinal metastasis(-es) after initial identification on staging imaging for a metastatic solid tumor?
The closest thing that I have done to prophylactic spinal (vertebral body) treatment would be if someone has a symptomatic spinal metastasis very close (within 2 vertebral bodies) that is going to have radiation treatment. I might include the asymptomatic one so that later there is less probability ...