Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend ISRT after salvage auto transplant for relapsed classical Hodgkin Lymphoma if the patient had Deauville 2 after ICEx2 prior to BEAM auto transplant and now has Deauville 1 imaging?
There are no randomized studies (to my knowledge) formally evaluating the role of consolidation RT in the setting of relapsed Hodgkin lymphoma (HL) and autologous stem cell transplantation (ASCT). Outcomes are universally worse in the salvage setting compared with upfront management. Therefore, it s...
What image guidance do you utilize for photon breast boost?
We usually use mV portal imaging.
Would you offer adjuvant radiation to a woman with a history of mastectomy and reconstruction for DCIS (no prior RT) who develops a cT1cN0 new primary IDC in the chest wall?
I would usually treat this recurrent/new primary with PMRT.
How would you treat superior sulcus NSCLC with small volume N2 disease?
The question of surgery for N2 NSCLC patients in light of current survival and LC rates in the modern RT era with immunotherapy remains unclear. Historically, for these superior sulcus NSCLC patients, surgery played a large role due to our inability to deliver adequate dose of RT because of proximit...
How would you manage a patient with cutaneous SCC of the lower extremity with isolated inguinal nodal involvement?
Good timing for this question, since I’m currently treating a similar case of Merkel Cell Carcinoma (MCC) on dorsal skin of wrist with isolated axillary nodal involvement. The same oncologic principles should apply for SqCC as well: As far as surgery is concerned, wide local excision (WLE) for the ...
Do you offer whole lung radiation with metastatic recurrence of Wilm's Tumor (FH, no LOH 1p16q)?
WLI should certainly be administered alongside salvage chemotherapy for metastatic recurrence. There are no definitive data on timing, but the earlier the better.See the relapse arm of NWTS-5 (Malogolowkin et al., PMID 17539021, Green et al., PMID 16547940) and AREN1921 for details regarding integra...
Would you offer adjuvant radiation for a grade 1 osteosarcoma of the mandilbe with close margins following surgical resection?
There is a good rationale for offering post-op RT in this setting. A relevant retrospective series from MDACC reported on ~120 patients who underwent surgery with or without RT (Guadagnolo et al., PMID 19382187). In this report, approximately 40% developed local recurrence, speaking to the high rate...
Do you offer adjuvant radiation therapy for sacral chordoma s/p gross total resection with close margins <0.5 cm?
Yes to adjuvant RT, but doses of 50-60 Gy have no benefit in chordoma. 70 Gy is required even with R0 margins. See Konieczkowski et al., PMID 32147017 for a full discussion of the literature.
How do you manage a cervical cancer that needs interstitial brachytherapy with prolonged thrombocytopenia after concurrent chemoRT?
Although infrequent, we have done pre op plt transfusion to make brachytherapy feasible and to avoid prolonging the total duration.
Is it essential to wait one week after loading dose of erbitux to start RT for head and neck cancer?
I would start RT if it means you're going to risk delaying RT start window. Another question is, why are you giving Erbitux for post-op treatment? Can you use another agent?