Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer reirradiation after resection of locally recurrent triple negative breast cancer only 6 months after completion of postmastectomy radiation?
If recurrence is in the prior full dose of RT then get concerned about the efficacy of reradiation when it didn’t work 6 months ago. If it is marginal area or in an area where dosing was inadequate, then yes. Also if have hyperthermia then it would be a good modality to add with reradiation in this ...
Would you offer RT for a patient with early stage breast cancer with a focally positive margin who was lost to follow up for over a year after surgery?
It’s too long of an interval for any benefit of adjuvant treatment. Needs mammogram and follow up along with relevant systemic therapy.
Would you offer PMRT to an ER/PR+, Her-2 negative cT3 tumor treated with neoadjuvant chemotherapy, but with a minimal treatment response?
The data on the risk of local-regional failure and the effect of PMRT on outcome are still too limited and contradictory to be certain of the correct answer. For example, the 10-year risk of LRF in the NSABP series of 95 cT3N0 patients having negative nodes but residual breast disease was 12% (1). H...
Would you recommend PMRT for stage IIA (pT1c pN1a) ER+/HER2- grade 2 IDC in an elderly patient with a single positive non-sentinel lymph node?
This is a patient where given comorbidities you have multiple options. I will often offer these patients 15 fractions to the chest wall with consideration of SCV. It's well-tolerated.
How would you approach the parotid volume for a PET avid intra-parotid node when planning definitive chemo radiation for a locally advanced squamous cell carcinoma of the oropharynx?
Beware Warthin’s tumor! I have a low threshold to biopsy given the quite small (but of course not zero) risk of parotid metastasis in the typical patient.
Would you include interconnecting skin in the radiation volume for a patient with lateral forehead squamous cell carcinoma who will receive radiation to the surgical bed and preauricular lymph nodes?
Yes. It's the interconnecting in-transit lymphatics rather than the skin that is the actual target. Since these are very superficial, an electron field would do the job.
Would you consider palliative radiation for a bone metastasis while patient is on pembrolizumab and axinitib?
If the dose to the hollow organs (in this case, the esophagus) is low, it should be OK to give axitinib (with anti-angiogenetic property) concurrently with RT. If the amount of lung exposed to radiation is small, it should be safe to give pembro (risk of pneumonitis) together. The above comments are...
What is the role of MRI in target delineation of radiation therapy for non-NPC H&N cancers?
I don't think MRI is necessary for most OPCs. I do use MRI in some cases, such as 1) patients being considered for surgery first (to determine if endophytic tumor is better suited for RT), 2) whenever I have clinical concern for perineural spread, and 3) to further assess deep invasion or involvemen...
How would you approach adjuvant therapy for a patient with pT2N2 lung adenocarcinoma who underwent an R1 resection and is not amenable to further surgical intervention?
I don't know that I have a trial (much less a randomized one) to prove this, however in this situation, assuming the patient has adequate functional status and has recovered sufficiently from surgery, I would treat the surgery as an extended biopsy. I.e., I would probably (with my radiation colleagu...
Are there best practices or data regarding the use of open notes among oncology patients?
The 21st Century Cures Act regulation (effective April 2021) required that clinical notes such as consult and office notes be shared with patients, e.g. “open notes.” In general, surveys of patients with cancer and their clinicians suggest that open notes are viewed favorably (Salmi et al., PMID 330...