Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a young man with a history of stage IA testicular pure seminoma s/p radical orchiectomy who has a solitary left inguinal lymph node recurrence and normal tumor markers?
Relapse in an inguinal node is somewhat unusual in testicular cancer unless there has been prior scrotal violation or surgery for maldescent. Trans-scrotal biopsy of the testis is usually an incorrect approach, as it can cause a different pattern of spread (to the inguinal nodes). Thus, I would not ...
Is ENI necessary for postoperative treatment of clinically N0 adenoid cystic carcinoma of the head and neck?
Adenoid cystic carcinoma (ACC) is an uncommon malignancy of the head and neck characterized by an intermediate growth rate and a propensity for local recurrence, perineural tumor spread, and distant metastasis. Historically thought to be radioresistant, patients were treated with surgery alone until...
Is it ever appropriate to omit temozolomide in unmethylated glioblastoma?
Perhaps a different perspective on this question would be which unmethylated patients would you be willing to not treat with up-front temozolomide? The genesis of the question and conundrum comes from the modest benefit described in the above-mentioned trials for this subgroup. As Hegi herself descr...
In patients with nasopharyngeal SCC that have an excellent response to induction chemo, do you alter your chemo-RT dose/volumes in any way?
I agree with Dr. @Dr. First Last. I do not change my volumes based on response to induction chemotherapy. It may be difficult to outline the nodal volume if there is complete response to chemo but I have not really encountered that scenario so far. I use the initial PET and diagnostic CT scans fused...
Is there a role for stents for patients with a new diagnosis of metastatic upper rectal cancer with a near-obstructing primary?
I haven’t had much luck with stents - they hurt, they often migrate, and tumor growth or perforation is also a risk. My preferred approach is a diverting colostomy, then total neoadjuvant therapy, then resection with eventual ostomy takedown. (This assumes curative intent disease.) Of course, this d...
What's your follow-up protocol for a near complete response (nCR) in rectal patients considering non-operative management (NOM)?
This is a question that comes up in our colorectal tumor board routinely. For patients with a near-complete response after the completion of TNT, we recommend repeating an MRI of the rectum and endoscopic exam ~8 weeks later. If there is still a lack of complete response, our formal recommendation i...
In patients with unresectable, liver-limited neuroendocrine tumors (NETs), what clinical or radiographic criteria guide your decision to prioritize systemic therapy over locoregional approaches?
The first question is always if it is truly unresectable... What is considered unresectable by some might be considered resectable by others, so I always recommend getting an opinion from an HPB surgeon with substantial experience in treating patients with NETs (whether that is done in person or at ...
How do you manage oxaliplatin-induced splenomegaly?
Oxaliplatin can lead to sinusoidal obstructive syndrome (SOS), which will result in portal hypertension. Splenomegaly is one of the portal hypertension signs.The SOS is correlated with cumulative oxaliplatin dose, and cumulative dose >1000 mg/m2 is considered a potential threshold (Overman et al., P...
Is there a scenario in which you would consider observation for T4a SCC involving the mandible?
While PORT is well established, the scientific basis for it is relatively weak in the absence of a randomized trial, as all phase 3 trials have focused on adding something to radiation rather than the benefit of radiation alone. Further, the rationale for PORT historically is if there is a belief of...
What is the role of adjuvant RT for metastatic RCC to the thyroid resected with high-risk features?
There is no established role for adjuvant radiotherapy after thyroidectomy for RCC metastases, even with high-risk features. Most published evidence consists of small retrospective series or case reports. When RT is used, it’s generally for palliation. That said, selected high-risk cases (positive m...