Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you ever consider focal brachytherapy treatment in a patient who have in-prostate recurrences after RT?
Yes, our preference is focal treatment for unilateral disease on imaging (PSMA, PET, and MRI) and concordant biopsies. Our data suggest that this is just as effective as whole gland treatment for recurrences with possibly less toxicity. For patients b/l recurrent involvement after prior radiation tr...
What do you quote as the recurrence risk without radiation for patients that undergo neoadjuvant systemic therapy followed by lumpectomy and are found to have a complete pathologic response?
We don’t have any data to quote and this is still an unanswered question. Rather, there is an interesting phase 2 study omitting surgery in these, it’s showing excellent outcomes.Kuerer et al., PMID 36306810
Is there any role for RT in the management of florid LCIS after mastectomy?
No role of radiation therapy in this case.
How would you manage a patient who received pelvic radiation 15 years ago and now has a 5 cm colon adenocarcinoma and squamous cell carcinoma of the anorectum?
I think the objective in a retreatment case like this is to maximize the chances of curing cancer with as little RT as possible. I would consider disease free survival with a functioning colostomy a better outcome than survival with an intact rectum but chronic difficult-to-manage complications. I w...
Do your radiation treatment recommendations change if a breast cancer patient does not complete a full course of neoadjuvant chemotherapy?
No. For the usual patient who has operable/resectable breast cancer, who is planned to have induction chemo followed by surgery, failure to complete the induction chemo would not alter my planned RT. Inherent to this question is the related question of: "Should we alter the RT plans based on the res...
Do you recommend adjuvant radiation for a recurrent pT1bN0 vulvar carcinoma?
For recurrence disease, if the depth of invasion is more than 1 mm and nodal assessment is not done then would favor/discuss RT. Data shows with each recurrence, risk of nodal involvement (15%) goes up which is hard to salvage Grootenhuis et al., PMID 26428940.
Would you consider radiation therapy before chemotherapy in a patient with stage I-II high-grade B-cell lymphoma presenting with a large necrotic skin lesion?
I would add that it is important to have a reasonable overall plan with Heme-Onc agreed upon to increase the likelihood of a successful outcome. Ideally, chemotherapy is administered first. This allows "consolidation" RT to be customized based on response. For example, a lower dose is utilized in a ...
How would you treat an essential-like tremor secondary to tumor (e.g. glioma)?
This is a great question. The first step in managing tremor in the setting of a tumor or underlying mass is to first determine the phenomenology. It is not uncommon for dyskinesias like chorea or dystonia to arise after onset of tumor or treatment of tumor. Thus, looking for subtle (or not so subtle...
In which situations do you consider post-mastectomy radiation therapy when the patient has a localized node-positive breast cancer with a complete nodal response and minimal residual disease in the breast post-neoadjuvant chemotherapy?
This is an area of open study as we await the results of NSABP B-51. Off study at this time, I discuss the role of PMRT with all patients, with cN1 patients with a pCR in the nodes. I discuss PMRT is likely to provide a locoregional recurrence benefit, though survival advantage is unclear. Factors t...
Are apocrine type TNBC breast cancers less sensitive to radiation?
Data suggest that behavior is less aggressive with less risk of distant mets than other triple negative cancer but from an RT perspective, treat like any other triple negative cancer.