Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach management of a young inflammatory breast cancer patient after a CR to neoadj chemo but refuses surgery?
I would first review the NCDB study showing the best outcomes for trimodality therapy (Reuth et al). Then explore why. If it is a belief CR means cured highlight imaging can be discordant. There will often be cancer found at surgery. If there is a pCR that is the best chance for cure but even with t...
How will you counsel patients receiving radiation therapy regarding COVID-19 vaccine administration?
Encourage to take the vaccine as scheduled (both during or after RT).
Is there a role for RT in localized nodal relapse of stage IV follicular lymphoma with the goal of delaying the need for additional systemic therapy?
Indolent lymphomas like follicular lymphoma typically present with diffuse disease and therapy for the disease is not curative. Oncologists vary in the aggressiveness of their treatment approach, but almost all medical oncologists would advocate for administration of systemic therapy before the pati...
Do you avoid adding high energy photons (with associated neutrons) for younger breast cancer patients, out of concern for secondary malignancy risk?
We used mixed, whenever appropriate, with optimization of dose distribution using field within field technique (no wedges).
How would you approach an early inguinal recurrence after surgical resection of Merkel Cell carcinoma in the popliteal region?
I would make sure there is no distant metastases with a PET-CT. Would try to enroll this patient in a trial. Current approach if localized in surgery followed by radiation, but with availability of immunotherapy, I would recommend at least an adjuvant immunotherapy after surgery. No one knows if rad...
How would you treat and delineate target volume for a pT1N2 NSCLC after wedge resection with clear margins?
In a patient who has undergone a wedge resection and who has negative margins, I do not see an indication for radiotherapy to the residual primary site or staple line, inasmuch as the surgical approach is not standard of care in operable patients. If wedge is done in a high risk operable patient, I ...
How would you approach the treatment of a patient with a history of cutaneous melanoma and only overt site of disease being a bulky level III axillary lymph node?
Surgery and postop RT.
Would you offer PCI to a patient with LS-SCLC, who presented initially with paraneoplastic syndrome (encephalomyelitis), but had no neurocognitive sequelae after chemoradiation?
I am not a big fan of PCI. I think the term itself is a misnomer. PCI trials in LS-SCLC were conducted in an era when MRI brains were not performed.Let's look at the "outdated" data that all of us, including NCCN, quote. A meta-analysis conducted by Auperin and colleagues demonstrated a 5.4% 3-year ...
What dose-fractionation scheme do you recommend for the treatment of leukemia cutis?
Leukemia cutis (LC) is a form of cutaneous extra-medullary leukemia that confers a relatively poor prognosis, with a median survival of <12 months. Since most of these patients have additional sites of involvement (spleen, liver, CNS), the mainstay of treatment of EMD leukemias is still considered t...
What is your hemoglobin transfusion threshold for asymptomatic pediatric solid tumor patients during radiation?
We aim for a Hb of 10g/dL whenever possible. This is not based on any data from pediatrics, but from data in adult patients (Prognostic value of hemoglobin concentrations and blood transfusions in a retrospective study of 386 patients).