Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach the discussion with a patient who is seeking proton therapy for early stage breast cancer?
I would ask why they want protons. Assuming they give the expected answer, I would say something like this: “Thanks for asking about that. I certainly understand why you might feel as if protons would be better for you. I understand that receiving radiation can be scary, and indeed, radiation can be...
Per the latest ASCO and ESMO guidelines, which stage II NPC patients would you omit concurrent cisplatin?
ASCO recommendations for stage II NPC are: “For T2N0 (AJCC 8th) NPC patients, chemotherapy is not routinely recommended, but may be offered if there are adverse features, such as bulky tumor volumes or high EBV DNA copy number. For T1-2N1 NPC patients, concurrent chemotherapy may be offered, particu...
How would you approach a recurrent, cutaneous SCC of the face with high-risk features s/p resection?
Likely previously treated with 6 MeV. Reirradiate the primary site and track nerves to skull base. Electively treat the regional nodes.
In what situations, if any, would you recommend adjuvant concurrent chemoradiation rather than RT alone?
I think think this is head and neck cancer? Cannot tell based on the question. Positive margins from an oncologic surgery (i.e., simple tonsillectomy with positive margins does not buy you the juice). Any pathologic ECE in the lymph nodes. I don't differentiate between focal and diffuse. The origin...
Should patients with co-existing moderate-severe valvular disease (particularly AS and MS) and malignancy requiring radiation therapy undergo more frequent surveillance surface echocardiograms?
The answer is yes, for some patients with baseline moderate to severe valvular heart disease receiving radiation, with the heart in the radiation field (i.e. left breast, lung, esophageal cancers), they should have more frequent surveillance echocardiograms.The 2020 ACC/AHA valve guidelines recommen...
Should we repeat a dose-escalation trial for stage III NSCLC in the era of modern radiotherapy techniques and dose constraints?
Yes to a study with modern techniques. The outcome was so odd that high dose was killing patients at a higher rate than with standard dose, despite many phase II and retrospective studies showing good outcomes. The subset analyses showing that IMRT was associated with better outcomes as well as more...
Would you alter your treatment algorithm for uterus mesonephric-like adenocarcinoma?
Very rare entity and would follow management principles for high grade (g3) endometrial cancer.
What radiation would you offer for isolated nodal recurrence in a patient who received APBI for breast cancer about 2 years ago after ALND?
If imaging is negative for IBTR, I would favor regional nodal RT only after dissection.
How do you handle the obturator prosthesis during radiation delivery for SCC of hard palate?
Leave it in if it’s not problematic.
How would you manage a Grade II IDH mutant astrocytoma with otherwise low risk features, but gemistocytic histology?
Not sure there is a right answer for this one - in general, for an IDH mutant grade 2 astrocytoma with low risk features, I would consider observation. If all else is low risk with the exception of gemistocytic histology, I may still consider observation and counsel the patient about an increased ri...