Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you incorporate immunotherapy in your multi-modality treatment after chemoradiation for patients with potentially resectable stage III superior sulcus NSCLC?
No. Durvalumab therapy in NSCLC is currently limited to patients with unresectable disease. PACIFIC clearly demonstrated an enduring survival benefit of consolidative Durvalumab therapy after combined chemo-radiation therapy in patients who did not undergo surgical resection. The NeoCOAST trial is c...
How would you treat recurrent unresectable sarcoma in previously irradiated maxillary region, with no distant metastatic disease?
This is a rare and challenging case (though I’ve actually seen this exact scenario a few times). I don’t think there’s a great answer, unfortunately. Re-irradiation with protons may be the best choice. Depending on the sarcoma histologic subtype, I would suggest clinical trial and/or NGS to determin...
When contouring presacral space for gynecological tumors for IMRT plans, how far inferiorly do you take your contour?
The new contouring atlas came out this month. For presacral node, caudal extent is the beginning of piriform muscle. Small Jr. et al., PMID 32905846
Is there a role for radiation therapy in the treatment of a lymphoproliferative disorder involving the orbit?
The great majority of lymphoproliferative disorders of the orbit turn out to be NHL when subjected to sophisticated pathologic evaluation, but even those which are considered benign lymphoid hyperplasia (LH) are often and successfully treated with radiotherapy. The dose of RT for low-grade lymphoma ...
Is there a role for radiation therapy after neoadjuvant systemic therapy and irreversible electroporation in patients with locally advanced pancreas cancer?
Both IRE and ablative radiation have results that indicate high local tumor control and OS from selected institutions with experience. IRE is not ionizing, it affects the cell membranes. Since radiation affects normal tissues through DNA damage, I can't think of a reason to be concerned. Dr. Martin ...
How would you manage a patient with locally advanced triple negative breast cancer s/p MRM, who refuses adjuvant chemo?
These are challenging situations. While the patient is refusing adjuvant chemotherapy, sometimes patients will consider concurrent Xeloda. If they will, I would give 50 Gy to wide post-op field (CW + RNI) and with areas of gross disease (ex. SCV, IM, retrosternal) boosted to 66 Gy. If the patient r...
Do you recommend a dose constraint for breast implants when treating a patient for NSCLC with radiotherapy?
There is no specific number, but with multi-beam RT dose received by the implants is low to moderate to be of any specific concern.
How would you manage an unresectable central meningioma in a young patient with evidence of mild compression on the optic nerve and 4th ventricle involvement?
Sometimes, unresectability is in the eye of the beholder. In a young patient, with a decent size meningioma compressing the chasm and the 4th ventricle, there are several significant risks from not pursuing a surgical approach. Our first approach would be to get an expert opinion from a renowned men...
Does invasive pleomorphic lobular breast carcinoma broaden your indications for adjuvant RT?
I would not add PMRT for ITC and pleomorphic T1 or T2 disease.
What is the radiation volume for unresected gross paraaortic lymph node in a Wilms patient?
This depends on the presence/absence of diffuse anaplasia (See AREN0321 [NCT00335556]) and age/field extent.Patients with diffuse anaplasia who are Stage 3 due to the presence of residual nodal disease would receive 19.8 Gy to the flank, and then in the presence of residual disease, would receive a ...