Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach treatment of the brain in a patient with ES-SCLC found to have CSF cytology positive for malignant cells but negative MRI of the brain?
A patient with extensive small cell lung cancer that is found to have + CSF cytology cannot be cured. The therapeutic focus should be symptom control and prolonged comfort. The treatment for ED-SCLC is systemic therapy. Commonly, that does not cross blood brain barrier. The question of whether to tr...
What planning techniques and constraints do you use when treating H&N cancer with VMAT as it relates to arcs that sweep through shoulders that ride high?
For VMAT planning, we do try to avoid beams from angles where the shoulders can get in the way. In Eclipse, this can be relatively easily accomplished by turning on avoidance sectors during optimization. If this function is not available, one can choose to split the arcs, which will be more work for...
Would you ever utilize quad shot specifically for a large SNUC?
The Quad Shot is palliative, while even in advanced SNUC definitive chemo-RT provides a chance for about 50% LR control at 2 years and long-term cure in 22% of patients. This is based on our results in 19 patients, almost all of whom had Kadish stage C or AJCC T4. In our experience, a surgical attem...
How would you approach treatment in a patient with well controlled ulcerative colitis planned for salvage RT?
This is a great question. In patients with well controlled UC or any inflammatory bowel disease, I typically will have no concerns treating them, which is supported by recent data/manuscripts.First and foremost, I have a discussion with the patient's GI doctor to make sure any medications or intrica...
How would you treat oligometastatic kidney cancer in a young, fit patient with recurrence <6 months after nephrectomy?
This is a good question. Short time to recurrence of mets would generally indicate more aggressive biology i.e., the mets aren't really oligo and other mets are lurking. Having said that, careful review of prior scans may reveal that the metastatic sites were present prior to being fully recognized ...
Do you offer consolidative RT to the pancreas for patients who initially present with metastatic disease and have radiographic CR after chemotherapy?
This is a highly selected group. Since the biology of treatment response correlates with longer survival, we do offer consolidative RT for these patients.
Would you offer adjuvant pelvic RTto a patient with distal sigmoid colon adenocarcinoma, following LAR with pT4a pN1 with + radial margins and no room for further resection?
Yes.
Would you consider 177Lu-Dotatate (Lutathera) in patients with midgut neuroendocrine carcinoma after treatment with a somatostatin analog but with Ki67 >20%?
PRRT with Lu-177 DOTATATE can certainly be considered in patients with well-differentiated G3 NETs. The expected outcomes are not as favorable as with G1/G2 NETs but better than with poorly differentiated G3 neuroendocrine carcinoma (G3 NEC) where PRRT should probably not be used at all unless in th...
Would you offer adjuvant radiation therapy for a Merkel cell carcinoma limited to the epidermis with close margins?
I would review this case with a dermatopathology expert before making any decisions. The reason is that normal Merkel cells usually lie in very close proximity to the basement membrane. My understanding is that a skin neoplasm that is limited to the epidermis does not broach the basement membrane, a...
How would you manage recurrent popliteal and inguinal LNs from melanoma?
1. Confirm no distant metastases. 2. Therapeutic lymphadenectomy if possible, followed by adjuvant lymph node basin radiotherapy, 48 Gy/20 fractions or equivalent in 2 Gy fractions. If BRAF altered, consider adjuvant dabrafenib/trametinib. If not BRAF altered, consider adjuvant ipilimumab. 3. If unr...