Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend treating pre-chemo volumes to full prescription dose for locally advanced nasopharyngeal cancer following induction chemotherapy?
I think it is reasonable if the purpose of the chemo was to shrink the primary away from OARs like the optic chiasm. Obviously, as @Dr. First Last says, if the tumor was exophytic, you don't need to treat the air. However, I would still include in my high dose CTV the pre-chemo routes of spread, e.g...
For patients with locally advanced EBV-associated nasopharyngeal carcinoma treated with induction gem/cis, what concurrent chemo regimen and scheduling do you typically use during radiotherapy?
Cis/gem induction is based on the paper by Zhang et al., PMID 31150573. They used 100 mg/m² every 3 weeks of cis concurrent. ~ 40% received 3 cycles, 50% 2, and 10% 1. As many have in our concurrent scenarios for HN CA, our medical oncologists prefer the weekly 40 mg/m². There remains no clear 2nd l...
What role do you see for functional imaging in selecting patients with HPV-associated oropharyngeal cancer for radiation dose de-escalation?
This study, led by Dr. @Dr. First Last, is unique in using F-MISO PET to select patients for a notably aggressive de-escalation plan, to a 30 Gy total dose for responding patients. We need to wait for long-term results before accepting it in the clinic, notwithstanding that F-MISO is not widely avai...
Can SpaceOAR be inserted a second time?
I had the same thing happen and placed a second SpaceOAR without difficulty. I also have a few cases where the patient had a local recurrence, and a second rectal spacer (after prior radiation with a rectal spacer) was used without difficulty. Please be aware that placement of a rectal spacer after ...
Which types of pancreatic cancer patients should we consider sending to a center that offers EUS-guided Radiofrequency Ablation (RFA) therapy?
EUS-guided ablation for appropriately selected mucinous pancreatic cysts and, to some degree, neuroendocrine tumors is becoming increasingly standardized with multiple reviews on the subject. (Rodger et al., Techniques and Innovations in Gastrointestinal Endoscopy 2024, Moyer & Canakis, PMID 3879629...
Would you offer empiric lung SBRT for two growing FDG-avid lung lesions in a patient with severe COPD on oxygen?
This is a good question! The short answer is yes, most likely. Many patients are too high-risk to receive biopsies; this is decided by surgery/pulm/IR. Unless the patient has contraindications to RT or something like severe IPF (where treatment may be worse than the disease), I would likely offer th...
Can RT to non-bulky sites be omitted in an early stage (stage I or II) classical Hodgkin's lymphoma case with a CR by PET/CT?
Randomized studies have consistently demonstrated that combined modality therapy is superior to chemotherapy alone in regards to progression-free survival in early-stage Hodgkin lymphoma. The magnitude of the benefit varies across studies, but a relative risk reduction of ~50% can be expected which ...
For resected oral cavity squamous cell carcinoma with indication for adjuvant radiotherapy to the primary tumor bed, would you routinely include ipsilateral and/or contralateral nodes even with a pN0 elective neck dissection?
Since the question states "routinely", the short answer is yes, but the longer answer is there is much more nuance to this.Some will say no based on Contreras et al., PMID 31246526.It is important though to recognize that this paper is a bit more complex and the details are critical.The question ref...
Should a patient who requires definitive treatment for prostate cancer as a pre-transplant requirement be strictly required to complete their course prior to transplant/initiation of immunosuppression?
To help address this complex question, I would like to call your attention to a review of the topic by Al-Adra et al., PMID 32969590. It covers several types of malignancies, including prostate cancer (Table 4). Treating this patient will require close collaboration with the transplant surgeon, urol...
In clearly resectable pancreatic adenocarcinoma with no arterial or venous involvement, is there a role for neoadjuvant chemotherapy?
There is currently equipoise regarding this question, and the Alliance A021806, a phase III trial evaluating perioperative versus adjuvant therapy for resectable pancreatic cancer, clinical trial will address it. There is a role in certain subsets of patients without clear vascular involvement regar...