Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you use SBRT to a localized low grade neuroendocrine carcinoma in the head of pancreas in a patient with high surgical risk?
Yes, this is a reasonable approach that has been reported previously in the literature for pancreatic neuroendocrine neoplasms (see: Myrehaug et al., PMID 32185093; Duran et al., HPB 2021 [abstract]; a single case included in Goyal et al., PMID 21937061 as well). SBRT in this setting often provides ...
Would you recommend post-operative chemoRT for a young female patient with cT2N0 rectal adenocarcinoma who had pT2N1 disease, with 1/21 lymph nodes positive?
I would also want to know the location of the tumor in the rectum and be sure that the patient had a TME. For a mid to high rectal tumor with a TME, I would definitely not recommend RT. For a low rectal tumor, the situation is a bit more difficult. However, since there were a good number of nodes re...
Would you use de-escalated radiation or chemoradiation therapy for an incidental finding of invasive squamous cell carcinoma but with clear margins in a hemorrhoidecotomy specimen?
Yes. Would include elective nodal irradiation.
How would you treat cT3N1 ER/PR (-), Her2 (+) breast cancer who had mastectomy + ALND with a pCR in the nodes but ypT1 disease in the breast?
Given increased pCR rates, this is something we are seeing more commonly. If possible, these cN1 patients are often undergoing SLN rather than ALND if SLN is negative. I would offer PMRT for this patient given initial nodal involvement with T3 and ER- disease. Until we get data back from B51, my sta...
When staging prostate cancer, does MRI pelvis/prostate replace CT A/P?
The NCCN guidelines and recent NRG protocols allow for either CT or MRI to stage the pelvis. Assuming the MRI includes imaging of the pelvic LNs, I am not aware of an added benefit of a CT. With the increasing use of novel imaging for staging such as PSMA PET (which can be more sensitive at detectin...
For patients with small, early stage breast cancers that undergo cryoablation, do you ever offer adjuvant radiation?
I would first counsel patients that outside of prospective studies, cryoablation is not a standard approach in the management of breast cancer and would refer to the breast surgeon for consideration of appropriate breast surgery.If on study or patient is unwilling to consider surgery, you can consid...
How would you manage a cT2, N0 poorly differentiated mucoepidermoid carcinoma with sarcomatous features/carcinosarcoma affecting the soft palate?
This is such an uncommon entity that one can only make a best guess, and in theMednet forum where only a brief synopsis is provided, it is even more challenging. In general, Mucoepidermoid cancers are treated with surgery, and the pathologic entity (of sarcomatous features) would not change this. T...
What chemotherapy do you use with radiation for urothelial carcinoma with squamous differentiation?
In case of primary or dominant urothelial carcinoma with squamous cell features, would approach similar to pure urothelial carcinoma and consider same radio-sensitizing chemo that we are using in S1806 phase III trial. Doses below may not fully reflect S1806 protocol and also depends on the patient ...
What would you offer postoperatively for a pt with resected 3 separate HPV+ SCC primaries with pN1 disease with ECE who is cisplatin ineligible?
In view of this patient having ECS and three primaries (including bilateral disease), I would definitely treat postoperatively with chemotherapy in conjunction with radiation therapy. I still favor a platinum-based regimen in view of this patient's neurological toxicity due to previous cisplatin exp...
Would you ever consider SBRT for de novo cutaneous squamous cell carcinoma?
No role for SBRT.