Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you include the neck in the RT field for resected thyroid cancer?
I will use external beam RT to the neck for medullary thyroid cancer, anaplastic thyroid cancer, or local-regional recurrence of papillary or follicular that is no longer iodine-avid, and thus cannot be treated by I-131.
How soon after completion of salvage RT to the prostate bed do you allow urethral dilation?
In my experience, anastomotic strictures do not resolve spontaneously or with treatment interruptions. In part, the answer to this question depends on how symptomatic the patient is and how close you are to the end of treatment. If the patient is totally obstructed or close to it, you're probably go...
Would you consider SBRT and adjuvant therapy for a 4cm, node-negative, non-oncogene driven, NSCLC not amenable to surgical resection?
Ultimately, currently open clinical trials will address this question (i.e., SWOG-S1914, NCT04214262). In the absence of this, there have been several questions here on this topic ranging from the possible role for adjuvant chemotherapy, incorporating ctDNA testing, and how to follow these patients ...
How do you manage a patient with early stage small cell carcinoma of the breast?
Few I have treated had outcomes similar to SCC at other site. Since surgery is already done, they all get PE chemotherapy and we follow up with whole breast hypofractionation RT.
Is it reasonable to omit nodal RT in an elderly patient with T3N0 SCC of the glottic larynx?
I would not omit ENI. It’s less morbid than a neck failure.
How would you approach local control in a patient with extra-osseous metastatic Ewing sarcoma of the kidney?
I would follow general guidelines for Ewing sarcoma – if the tumor is completely resected, no RT. If spread outside post surgery, then would follow Ewing Sarcoma dosing guidelines.
In a patient with stage III NSCLC who was treated with neoadjuvant systemic therapy and had a PR, would you deliver RT to all sites of initially involved disease, or only residual sites of disease?
I struggle with this one quite often. The data would suggest that you need to treat all initial sites, but of course, that's not the purpose of those studies (defining what sites, dose to sites, etc) and there's almost assuredly something going on with that aspect of the therapy. The other way to th...
What is the role for consolidative ISRT for patients with stage III follicular lymphoma following a good response to systemic therapy?
Advanced (stage III-IV) follicular lymphoma is not considered "curable" with either chemotherapy or immunotherapy (or the combination). A complete response may be achieved but an eventual relapse is inevitable. For patients who are asymptomatic without bulky or threatening disease, current guideline...
What is the role of radiation therapy in a patient with diffuse cutaneous melanoma metastases who cannot tolerate systemic therapy?
The role of radiation therapy in diffuse cutaneous melanoma is palliative.
Do you use adjuvant radiation therapy for low grade biliary neuroendocrine cancer with positive margin?
Yes.