Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach adaptive planning in lung cancer?
The role of adaptive radiotherapy in lung cancer is still under investigation. I do daily CBCTs on my definitive NSCLC and small cell lung cancer patients. I only adapt plans if there is a change in anatomy such as opening of a collapsed lung or tumor growth outside of the PTV. I do not shrink volum...
Is SBRT appropriate for a small endobronchial tumor distal to the proximal bronchial tree?
In my opinion, you can approach them like any other peripheral NSCLC. There are challenges with small tumors in terms of finding them on CBCT sometimes and getting the dose in if they are very small. The 0236 protocol mandated a minimum aperture of 3.5 cm, which made it not very useful to treat tumo...
Does p16 status (HPV) influence your decision on whether to offer adjuvant chemoradiation or radiation in node positive H&N cancers?
No, p16 status should not influence the decision for initiating adjuvant therapy as p16+ patients have similar risks for failure after surgery as p16- patients without adjuvant care. Whether these patients may receive de-escalated therapy as part of a clinical trial is a separate question from wheth...
Would you treat the chest wall alone in a patient that had a previous prophylactic mastectomy and later developed an early stage breast cancer pT1-2N0 after a "lumpectomy"?
If nodes are not assessed surgically this time, I would treat level 1 and 2 for sure with supraclv based on other risk factors.
Would you offer radiation to the contralateral breast if after neo-adjuvant chemo and prophylactic contralateral mastectomy yielded ITC only in a single lymph node and no breast primary?
Other factors would influence my decision. What was the burden of disease for starting NACT on ipsilateral side? Could this be spread from the contralateral breast to the lymph node? Was MRI imaging done prior to chemo? Did staging show any enlarged contralateral node? Pre-treatment work-up/findings...
Which chemotherapy regimen do you prefer for concurrent treatment with radiation therapy for anal squamous cell carcinoma?
When you have a highly successful treatment such as radiation with concurrent mitomycin and 5-FU in a rare disease such as epidermoid carcinoma of the anal canal, it is extremely difficult to improve outcomes by improving the chemotherapeutic/radiosensitizing effect. The recurrence rate is so low no...
What palliative radiation dose would you give to a patient with vulvar cancer who has an inguinal recurrence in a field previously irradiated with 45 Gy?
If only site of relapse, I would treat with definitive doses to the volume based on previous treatment and use conformal RT to avoid femoral head and neck region.
What combination of clinical and pathologic features would lead you to be comfortable recommending active surveillance in a Gleason 7 prostate cancer patient?
Active surveillance (AS) is an important option for prostate cancer patients, especially for low risk prostate cancer. For intermediate risk prostate cancer, the risk of AS increases somewhat but the benefits of AS remain. To keep the risk of AS acceptable, one should select intermediate risk patien...
Should chemoradiotherapy to primary and neck be offered to patients with Stage IVC nasopharyngeal carcinoma with limited osseous disease?
Yes. Please refer to the recent small phase III randomized trial: You et al., PMID 32701129. Anecdotally, I have treated an Asian patient with EBV-associated NPC who had a single sternal met at presentation with definitive chemoxrt (no induction) who is is ~7 years post treatment and is NED.
If small cell carcinoma was found in an axillary lymph node with an unknown primary, would you recommend axillary lymph node dissection prior to chemoradiation?
Just to be clear, is this a patient with lung cancer? I know this is posted in the thoracic section, and has been responded to by a thoracic specialist, but usually “small cell carcinoma” in axillary lymph nodes without disease (especially in the thorax) elsewhere is Merkel cell carcinoma (cutaneous...