Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When, if ever, do you recommend concurrent chemotherapy with definitive RT for early stage oral cavity squamous cell carcinoma?
Early stage oral cavity cancers are best treated with surgery or definitive RT including brachytherapy. If brachytherapy is not feasible and surgery is not an option, I would consider adding cisplatin but it would not be my first choice.
How would you treat an isolated pancreatic adenocarcinoma recurrence in the post-op bed with progression through chemotherapy and no prior radiation therapy?
These tumors can usually be treated more easily with definitive doses of radiation because the duodenum has been removed. We are presenting our 69pt experience treating isolated local recurrence with ablative doses at ASTRO this year. Doses: 100Gy BED, (50Gy/5#, 67.5/15#, or 75Gy/25#). Median OS: 26...
What radiation lung dose constraints should be used for a standard fractionation plan in patients recovering from recent immunotherapy induced pneumonitis?
Since immune mediated pneumonitis tends to be a more global/diffuse process, I'm much more concerned about low dose spillage throughout the lung. IMRT is so commonly used for treating lung cancer so we often forget that trying to minimize low dose spillage (i.e. V5) may be better accomplished throug...
What is the best approach to organ confined squamous cell cancer of the prostate?
This is a very unusual situation in the US and other developed countries. Most of the patients with this histology tend to have other chronic illnesses to the pelvis prompting the development of this chronic inflammatory driven disease. As such, they can represent difficult situations to treat. From...
When do you offer a boost for patients receiving 5 fraction whole breast radiation as per UK FAST Forward?
Any data (convincingly) supporting the use of boost comes from the non-hypofx era. In the START A/B trials (which included many "traditionally boostable" patients), boost/no-boost outcomes were analyzed (left up to each center's/doc's preference), and boost had an almost perfectly zero effect on out...
How would you treat a biopsy-proven isolated uterine cervix metastasis of adenocarcinoma from a known colon cancer primary, previously stage IIIb at diagnosis two years prior?
We have dealt with few similar cases in the past few years. The overall management will depend on the patient's prior history - did she get any neo-adj or adj radiation within the pelvis for prior cancer? How large is the cervix metastasis? A multi-disciplinary management is paramount with involveme...
Does your adjuvant radiation approach differ for ependymomas with RELA fusion?
Ependymomas (EPN) can occur either in the cord, the posterior fossa (PF), or supratentorially, and are found both in adults and children. At a very high level, the standard management consists of resection followed by radiotherapy. Although various chemotherapy regimens have been used in several set...
How do you dose concurrent chemotherapy with once daily radiation for bladder preservation in urothelial carcinoma?
Two contemporary trials which used daily radiotherapy and concurrent chemotherapy are BC2001 and RTOG 0712 with concurrent chemotherapy schedules as below. Other regimens such as platinum alone have been reported on as well.BC2001: 5FU: 500mg/m²/d d1-5 & d16-20 MMC: 12mg/m² d1 Rationale: The study...
How would you manage T4N0 NSCLC with two separate nodules in different ipsilateral lobes?
If there is no lymph node involvement and the two lesions are amendable by SABR, I would TX definitive with SABR for curative intent. The role of adjuvant TX is debatable, depending on molecular profiling and PD-L1 expression level. If not SABR, hypo-fractionated RT or concurrent chemo/RT could be c...
How do you approach a patient with unfavorable stage II Hodgkin's lymphoma who achieved cCR after 6 cycles of systemic therapy but developed acute pericarditis with non-malignant effusion after 2 fractions of consolidative radiation therapy?
Not an answer but a bump to this question in the hopes that someone with experience will provide some input. I have a left breast cancer patient without cardiac history who is halfway through treatment with signs/symptoms and echo/EKG consistent with pericardial effusion likely secondary to acute pe...