Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can CM577 regimen of adjuvant nivolumab s/p neoadjuvant chemoRT with residual disease following surgery be extrapolated to patients with R1 resection unable to undergo re-resection?
This is an excellent question and, of course, one for which there are no data. So, unburdened by data, I'm free to offer my personal opinion. I think all of us would value other comments and responses to this question as well.I think that this question also applies to those patients who achieve a cl...
How young is too young to treat a child's keloid with radiation?
I think this is a helpful question and I think the following questions appropriately highlight the considerations. We do not routinely see or manage these at our center, so I welcome comments from the invited respondents.This is a controversial area and I think there are certainly exceptions which s...
When do you offer adjuvant radiation therapy for high grade non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) in a skeletally mature teenager or young adult?
ARST0332 tested whether a risk stratification system based on clinical prognostic factors would separate young patients with non-rhabdo STS into different prognostic subgroups and whether each factor used for allocation would be a strong predictor of outcome. A combination of factors was used to ass...
Would you offer radiation to an elderly patient with cT2N1 triple negative breast cancer, whose lumpectomy and ALND showed a complete response to neoadjuvant chemotherapy?
Yes, would offer. This question is to be answered on NSABP B51, in regards to how to manage the axilla in patients who have a complete response in the nodes. All patients with intact breast receive at least breast RT. The primary endpoint is if breast/chest management with or without RNI will reduce...
Is there a maximum period of elapsed time after which you would no longer consider radiation to a positive margin following surgery for NSCLC?
There's a lot to consider in a situation like this. All the available data (to me at least) suggest the role of PORT is local/regional control. In the advent of good chemotherapy, the role in a true adjuvant setting is pretty small/none. What you're describing is this rare gray zone of positive marg...
Do you look at or constrain V10 lung dose for your IMRT esophagus patients?
I have a few general comments about dose constraints that applies not just to this question, but to normal tissue constraints generally. The first is to keep in mind that, to a great extent, the various lung constraint parameters are correlated. Therefore, in many situations, it might not matter whi...
In what situations would you offer salvage radiotherapy for relapsed/refractory DLBCL?
There are a number of different clinical scenarios when I would consider RT in patients with relapsed/refractory DLBCL. NCCN guidelines (page BCEL-7 and BCEL-8) list RT as an option in several of these settings.1. Relapsed disease s/p autologous or allogeneic stem cell transplantation - In patients ...
Would you offer the UK FAST Forward regimen to a patient with prior breast augmentation?
With a prior breast augmentation, I would not offer FAST-Forward regimen given the lack of data. I am not aware of data with the regimen and breast augmentation.
In stage II/III node positive patients with driver mutations positive NSCLC who are not surgical candidates and are unlikely to tolerate concurrent chemotherapy and radiation, would you consider radiation alone, TKI alone, or would you ever consider TKI + RT?
I am not aware of any data in this regard. Recently, we treated a 78-year-old female patient with MET exon 14 skipping mutation NSCLC with bilateral mediastinal and bilateral supraclavicular lymph node involvement on radiology scans. We were concerned about her ability to tolerate concurrent chemoth...
What radiation dose and fractionation is appropriate for hairy cell leukemia presenting as an isolated skeletal lesion, where systemic treatment is not recommended?
If the patient is not a candidate for any systemic therapy like cladribine or pentostatin, treatment of the bone lesion to 20-30 Gy with conventional fractionation is a reasonable approach. Some of the older case series would treat lesions up to 60 Gy, but HCL is ultimately a radiosensitive B-cell l...