Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In what situation, if any, would you combine immunotherapy concurrently with radiation for patients with head and neck cancer?
In the definitive setting I would only use this combination in the setting of a clinical trial. In the recurrent/metastatic setting would consider for patients in need of palliation or with progression in a limited number of sites (with good responses elsewhere). I would prefer this be done on proto...
In what scenario, if any, would you treat a unilateral neck (vs. bilateral neck) for post-operative oral cavity (in historically midline structures such as oral tongue, FOM etc) SCC patients?
For midline oral cavity structures I always treat bilateral necks. This is true even for well lateralized oral tongue cancers. There is a very rich lymphatic network for oral tongue and floor of mouth and involvement of level 4 while skipping levels 1-3 on the ipsilateral side as well as contralater...
What treatment would you recommend for a 3 cm basal cell carcinoma of the perianal skin with anal canal involvement?
I would confirm with adequate bx that it is not basosquamoid as then management would be chemo RT like anal cancer If indeed it is rare basal call ca and since Anal canal is involved I would treat with RT alone with conventional fractionation to close to 60 Gy like skin cancer
Would you recommend adjuvant chemoradiation for a resected ampullary adenocarcinoma?
There is no clear cut answer to this question. There is suggestive evidence from retrospective studies that adding radiation therapy to a chemotherapy regimen improves outcomes, but those are retrospective and non-randomized, with all the inherent difficulties in those analyses. The limited randomiz...
How do you approach SBRT and constraining healthy liver for a small liver?
Unfortunately, there is no simple answer to this question. Someone with 700 cc of liver could be doing quite well or on the verge of (or in) liver failure. If their liver function is poor and they only have 700 cc of liver, there is a better chance that you will hurt the person by treating them with...
How do you balance the need for wound healing and time to treatment initiation in head and neck cancer patients who require a second operation?
Avoid situations where you need a second operation, do the second operation after RT if possible, or do the second operation and start RT within 4 to 6 weeks and accept a higher likelihood of recurrence.
Should we be shrinking rectal cancer fields?
I think this is a good point. However, I think we need to consider the nuances of the question. First PROSPECT included: patients that "had cT2N+, cT3N-, cT3N+ rectal cancers deemed appropriate for neoadjuvant therapy prior to low anterior resection with TME. Patients with distal, T4 tumors, threate...
Does the risk of bowel complications change in a case where there is bowel invasion in a non functioning portion of sigmoid after diversion in a gynecologic malignancy getting CRT + brachy?
The type of bowel complications would define the risk of being symptomatic. Diversion will help with the future risk of fistula but the patient can still develop symptomatic necrosis. That being said, I would prioritize cure in this situation as persistent disease would cause more symptoms.
Do you ever treat a recurrent breast cancer with RNI alone rather than chest wall and RNI?
As this is a de novo case and not a recurrence, it would be reasonable to treat the nodes and leave the chest wall alone given the small size, absence of LVI, and adequate margins.
How do you approach an elderly patient (~80 years) with stage IIC melanoma post resection with oligometastatic brain lesion post intracranial resection which developed 2 years after treatment?
If I am understanding this correctly, then all known metastatic recurrence has been resected.In that case, I recommend cyberknife/SRS to the surgical cavity followed by single agent anti-PD1 therapy. Concurrent administration of anti-PD1 with SRS or GKRS is experimental at this point. There is no co...