Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you use amifostine in head and neck cancers?
In our practice we have not used amifostine for at least 6 years. The toxicity associated with amifostine, improvements in radiation conformality, and decreased PTV expansions have all contributed to this change in use.
Would you recommend APBI in an otherwise suitable candidate who is undergoing chemotherapy?
I would offer patients APBI in otherwise suitable patients who are undergoing chemotherapy. I discuss with medical oncologist to ensure treatment is sequenced with RT first but have not used the receipt of chemotherapy as a contraindication. Additionally, patients may not know whether they will be r...
Do you offer PCI for resected mixed histology lung cancers with a minor component of small cell?
Most mixed histology small cell and many resected cases are from removal of solitary pulmonary nodules. If there is foreknowledge of a small-cell component, more attention to N1 and N2 stations is warranted. If nodes are clear, chemotherapy remains warranted but likely thoracic radiotherapy (TRT) is...
Would you consider PCI for a patient with neuroendocrine carcinoma of the esophagus?
No. The role of PCI is currently being reconsidered even for lung small cell lung cancer - where PCI has been established after Auperin meta-analysis in Limited Stage and EORTC randomized trial in Extensive Stage. The problem with older studies - both the older studies from 1980s that were included ...
Would you ever NOT recommend adding concurrent chemotherapy to adjuvant radiation in +ECE oropharynx SCC patients who can tolerate it?
For now, always CCRT post op for ECE.
What is the maximum number of metastatic sites you would treat with consolidative radiation for a patient with high-risk neuroblastoma?
5 sites, per ANBL 1531
Would you ever recommend radiation alone for a T1N0 anal cancer?
The standard of care for almost all anal cancers (even small node negative tumors) is concurrent chemoradiation, as it is associated with a better colostomy free survival and disease free survival compared to treatment with RT alone. There is a retrospective study showing a 2 fold increase in loco-r...
Would you ever treat the internal mammary lymph nodes in a high risk patient who is axillary sentinel lymph node negative?
I would consider in a high risk node negative patient- ex. age < 40, ER-/Triple negative, LVSI + with inner quadrant disease. However, I would look at dosimetry achieved and only include if I can meet both IM coverage constraints and heart and lung constraints.
Would you ever start radiation in the middle of cycle 1 of chemotherapy for LS-SCLC?
The goal is to get RT started early in the course, and to maximize the concurrent part of the therapy. But of course a patient only gets chemo for a few days per cycle, and we don't know whether the ‘concurrent’ effect is entirely due to those days treatment, or whether the radio-sensitizing effect ...
Do you routinely use hippocampal sparing techniques in the treatment of primary brain tumors?
The hypothesis of the hippocampus as an organ at risk centers on the exquisite radiosensitivity of neuro-regnerative stem cells located within the hippocampal dentate gyrus and important for memory formation. Pending results from NRG CC001, a recently completed phase III trial of whole-brain radiot...