Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage prostate cancer in a patient who received prior chemoradiation followed by LAR for rectal cancer?
In this situation, I would recommend brachytherapy, assuming the patient has sufficient rectum to visualize the whole prostate gland (a pre-procedure volume study or in-office transrectal ultrasound will give you the answer). Either LDR or HDR, as both have data to support use in prior pelvic or pro...
What is your approach to elective radiation of the neck with primary cutaneous squamous cell carcinoma?
The ASTRO Clinical Practice Guidelines for treatment of BCC and cSCC (Likhacheva et al., PMID 31831330) provides specific guidelines for elective treatment of draining lymphatics. A thorough review of the literature revealed that the most important predictive factor for occult lymphatic spread is tu...
Do you routinely recommend proton therapy for whole ventricular radiation for intracranial germinoma after chemotherapy?
The pattern of failure data from SIOP GCT '96 (Calaminus et al., PMID 23460321) and the SFOP-90 experience (Alapetite et al., PMID 20716594) in which patients with localized CNS germinoma were treated with induction chemotherapy followed by focal radiotherapy was predominantly intraventricular. Ther...
Would you utilize single fraction palliative radiation therapy for a large bone metastasis?
The issue of field size was addressed in an early RTOG study (RTOG 78-10) where they looked at half-body RT. It was extremely effective with 73% partial or complete response and fast-acting, with 50% of patients experiencing relief within 48 hours. (Salazar et al., PMID 2423225). Patients could be r...
What is your local therapy paradigm for unresectable pelvic EWS cases?
Unresectable pelvic Ewing sarcoma tumors are treated with definitive radiation therapy. The Children's Oncology Group local failure analysis of patients treated on INT-0091, INT-0154, and AEWS0031 demonstrated pelvic tumors treated with radiation therapy alone had a local failure incidence of 22.4% ...
Do you incorporate immunotherapy in your multi-modality treatment after chemoradiation for patients with potentially resectable stage III superior sulcus NSCLC?
No. Durvalumab therapy in NSCLC is currently limited to patients with unresectable disease. PACIFIC clearly demonstrated an enduring survival benefit of consolidative Durvalumab therapy after combined chemo-radiation therapy in patients who did not undergo surgical resection. The NeoCOAST trial is c...
How would you treat recurrent unresectable sarcoma in previously irradiated maxillary region, with no distant metastatic disease?
This is a rare and challenging case (though I’ve actually seen this exact scenario a few times). I don’t think there’s a great answer, unfortunately. Re-irradiation with protons may be the best choice. Depending on the sarcoma histologic subtype, I would suggest clinical trial and/or NGS to determin...
When contouring presacral space for gynecological tumors for IMRT plans, how far inferiorly do you take your contour?
The new contouring atlas came out this month. For presacral node, caudal extent is the beginning of piriform muscle. Small Jr. et al., PMID 32905846
Is there a role for radiation therapy in the treatment of a lymphoproliferative disorder involving the orbit?
When I don't have pathology/flow/PCR reports diagnostic of malignancy, I have treated patients with "lymphoid atypia", "atypical lymphoid infiltrate", or "lymphoproliferative disorder" with symptomatic disease to 4 Gy in 2 fractions. I have a collection of such patients (about a dozen), almost all o...
Is there a role for radiation therapy after neoadjuvant systemic therapy and irreversible electroporation in patients with locally advanced pancreas cancer?
Both IRE and ablative radiation have results that indicate high local tumor control and OS from selected institutions with experience. IRE is not ionizing, it affects the cell membranes. Since radiation affects normal tissues through DNA damage, I can't think of a reason to be concerned. Dr. Martin ...