Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer partial breast radiation to a women who otherwise meets suitability criteria but is not going to receive endocrine therapy?
6 Gy x 5 APBI or 5.2 Gy x 5 whole breast based on technical suitability.
What additional pathologic or clinical features might sway you to recommend PMRT specifically for a very young patient with pT1 sentinel node negative breast cancer?
At this point, unless margin positive, I have not been offering PMRT for above subset.
How would you treat osteosarcoma that has relapsed with unresectable pulmonary metastatic disease?
Typically, I will discuss with the medical oncology team regarding systemic therapy options available as well as clinical trial options. With limited numbers of pulmonary metastases, you can consider SBRT and I have used a regimen of 60 Gy/5 fx.
Is it acceptable to treat vulvar cancers with split course radiation?
Unless the planned course is for palliation, split course is not suggested.
Would you consider treating a patient who has an unresectable slowly growing PET avid lung mass with concurrent chemo RT when multiple biopsy attempts have only resulted in pathology "suspicious" for adenocarcinoma of the lung?
I would consider treating the patient if they have a highly suspicious biopsy with the proper clinical context and after speaking with the pathologist to understand why the report indicates only "suspicion" rather than "confirmation". The patient in question had "multiple biopsy attempts" and demons...
Would you recommend hypofractionated salvage or adjuvant prostate XRT in the COVID setting?
The short answer is no. It's getting harder to justify recommending adjuvant RT these days in light of the recently published randomized trials and meta-analysis showing no benefit to adjuvant over very early salvage. I would monitor patients in this category. As for salvage, unlike primary RT, ther...
In locally advanced EGFR-mutated NSCLC with initial good response to osimertinib, how do you manage local progression of the primary?
In this context, local progression at one site after a good response to osimertinib makes good clinical sense. Given that the next line of therapy is chemotherapy, being able to continue the TKI as long as possible while addressing oligoprogression with RT for local control is appealing. However, we...
When, if ever, would you cover the clinically uninvolved contralateral oropharynx when treating a well-lateralized oropharyngeal cancer of the head and neck?
The main concern regarding another occult primary in the contralateral OPC is whether or not the ca is smoking/alcohol-related, in which case field cancerization is common and there is a risk of secondary HNC. This risk is much less in HPV+ with little smoking. A SEER study from 1975-2006 found that...
Is it safe to treat a recurrent esophageal SCC with definitive chemoradiation after a prior endoscopic mucosal resection?
I would not be concerned about perforation or fistula formation. With an EMR, the resection takes off the mucosa/submucosa and leaves the wall intact. There should be sufficient time from the prior procedure to have full mucosal regrowth and the wall integrity should be well maintained.
When is pelvic lymph node dissection indicated in vulvar cancers?
GOG 37 established adjuvant RT to pelvis and groins better than PLND for inguinal node positive patients. Pelvic recurrence rates were similar in both arm with the predominant difference being in inguinal recurrence. PLND as part of routine management in vulvar ca is hardly indicated.