Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you start a vaginal dilator after EBRT to the vaginal canal?
Although I have not reviewed the published data in a while, from my data review ~8 years ago and my own cumulative gynecologic specialty experience, I have fallen into the following paradigm: In the setting of standard EBRT or vaginal cuff brachy, for a patient, in reference to the use of a vaginal ...
What is the role of radiation in intra labyrinthine (cochlear) schwannoma?
This is a bit of a tricky question to answer without knowing the size of the lesion, the age of the patient, their current symptoms, and whether they have serviceable hearing.If the tumor is small, and the patient has residual serviceable hearing, it might be best to delay treatment and order a repe...
Do you wait to treat small asymptomatic brain metastases until they reach a certain size?
I typically treat all lesions on MRI that are found to be concerning for brain metastases. This is after a discussion with our neuroradiologist colleagues. If there is uncertainty that a small lesion may not be a brain metastasis, then I will elect to follow with a surveillance MRI and treat in the ...
How would you treat an isolated para-aortic recurrence while receiving adjuvant pembrolizumab after definitive chemoradiation for cervical cancer?
If the patient has failed while on pembro, I would favor holding/stopping IO and plan for definitive chemo-RT to the para-aortic region with SIB boost with weekly cisplatin.
Would you employ high tangent fields for a sentinel node biopsy with isolated tumor cells (ITCs)?
Several studies have found that patients treated with upfront total mastectomy and sentinel lymph node biopsy without PMRT or axillary lymph node dissection had very low rates of axillary recurrence or local-regional relapse. For example, the Dutch MIRROR study conducted from 1998-2005 enrolled pati...
Do you offer low-dose radiation therapy for osteoarthritis of the spine?
DEGRO has published guidelines on this very topic, so I would respectfully disagree with a comment arguing a lack of data. Of course, if one is looking for level 1 data on irradiating benign diseases in general, there may be little to satisfy.That being said, there's no level 1 data espousing the be...
How do you interpret recent large retrospective analyses comparing radical prostatectomy vs. radiation for prostate cancer?
There have been numerous comparisons of RT vs. RP from a variety of study teams with various conclusions, and it often seems like the principal conclusion of the study is best predicted by the subspecialty from which the authors originated (urology vs. radiation oncology). As the question partially ...
For a pathologic Stage I squamous cell carcinoma of the oral tongue with negative margins and adequate neck dissection, is perineural or lymphovascuar invasion alone an indication for adjuvant radiotherapy?
I think Dr Eisbruch is spot on- patients with PNI do worse in the surgical literature, but the benefit of XRT in this scenario to obviate recurrence is far from robust. My personal belief is that PNI is not a sign of neurotropism like in melanoma or adenoid cystic ca, but likely another surrogate fo...
How would you apply the results of CheckMate 204 in an asymptomatic patient with 10-20 metastatic brain lesions on dual immunotherapy for melanoma?
The results of CheckMate 204 showed that systemic therapy with both nivolumab and ipilimumab has clinically meaningful efficacy in patients with asymptomatic, untreated melanoma metastases to the brain. In this phase 2 study, however, only 22% of the patients had 3 or more lesions. Nevertheless, int...
How do you decide between initial radiotherapy vs systemic therapy in patients with metastatic melanoma and brain metastases?
An interesting question the answer to which is changing!For discussion we will assume that the patient is not previously treated. Presence or absence of CNS symptoms is likely the most important way to dichotomize these patients. Other issues include number and size of the brain metastases, whether ...