Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you give Cetuximab concurrently with SBRT for recurrent head and neck cancers previous treated with definitive radiation?
This is an area of active clinical trial development esp. as it relates to immunotherapy concurrent with SBRT. That being said, we certainly have phase I, II, and preliminary phase III data suggesting that SBRT in the setting of recurrent disease is safe and may offer extended LR control rates in a ...
In what situations would you consider memantine when treating multiple brain metastases with SRS?
The study by Brown et al., PMID 23956241 showing the benefit to memantine in terms of delay/decrease in neurocognitive function was in patients receiving whole brain radiation therapy. That is why I routinely offer memantine to patients receiving WBRT. (Even with the study results, I almost always h...
How do you manage a T1N0 well differentiated anal margin squamous cell carcinoma with low-grade dysplasia at the surgical margin who has already undergone re-excision and is not eligible for further excision without an APR?
There is absolutely no role for the adjuvant treatment of carcinoma in situ or dysplasia in anal margin squamous cell carcinoma. The reasons for this are that 1) This is not cancer. The patient will live a long time. If you cause any long-term effects in a person who does not have cancer such as pai...
Do you offer partial breast irradiation to woman with a germline variant of unknown significance (VUS) who otherwise fall into the "suitable" ASTRO category?
I would feel comfortable offering an otherwise suitable patient PBI with a VUS.
What dose regimen would you use to treat a patient with locally advanced esophageal SCC of the mid-esophagus who refuses chemo and surgery, agreeing only to radiation alone?
The 5Y survival of RTOG 8501’s RT alone arm was 0%. They used 64/32 Gy. So... I tend to think that RT alone is purely palliative and generally stick with 40/15 to provide palliation and hopefully some local control. 50/25 not unreasonable, but please don’t use the RT alone arm of the chemoRT vs RT s...
Would you treat a vulvar SCC with definitive chemoRT with 50.4 Gy IMRT then boost the GTV with en face with electrons to ~6400?
There is no "one fits all" for vulvar cancer, which is a complex disease with varying disease presentations. The ideal method of boost and the dose depends on the size, location, histology, and other factors. We used to use en face electron boosts much more frequently before we began using IMRT. It ...
What risk, if any, do you quote for erectile dysfunction in a young male being treated for a lumbosacral ependymoma?
I have not been quoting a specific risk of ED in spinal ependymoma patients. ED is common with advancing age and is often multifactorial. In ependymoma, prior spine surgery, the disease itself, concurrent medication, concurrent health issues, and the psychological impact of a cancer diagnosis are, f...
Would you ever recommend post-op CRT for gastric adenocarcinoma treated with upfront surgery and D2 resection with R0?
I would agree that chemotherapy without radiation is the current standard of care. INT-0116 notwithstanding, the ARTIST trial did not show a benefit to chemoradiation over chemotherapy alone. An unplanned subset analysis suggested a benefit to radiation in node-positive patients. The subsequent ARTI...
For a patient with cardiac sarcoma, is there a minimum ejection fraction to proceed with adjuvant radiation therapy?
Adjuvant radiation therapy is often indicated for cardiac sarcoma because tumor resections are often incomplete or done with close margins. However, cardiotoxicity is a major issue, especially since patients will often receive doxorubicin-based chemotherapy, which has inherent cardiotoxicity. That b...
How would you manage a imaging suspicious undissected (ipsilateral) lymph node in the setting of post-op RT for an oral cavity cancer with extensive nodal disease and ECE?
Chemo RT, 70 Gy to the node, followed by PET CT in 3 months.