Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What treatment sequence do you follow for patients with rectal cancer who are candidates for both PROSPECT and TNT/Watch and wait?
Thanks for this question. I am not sure whether this is up to us. This is up to our patients to choose which modality they would like to omit (radiation vs surgery). I would point out that a good quality MRI rectum should be performed to r/o any T4/N2 disease or potential requirement for APR. Otherw...
Given results of the RADICALS trials, is LT-ADT standard of care for salvage prostate RT?
I do not think long-term ADT is established as standard of care for salvage prostate radiation, as this would require a demonstration of improved overall survival in at least specific subgroups of patients. RADICALS-HD demonstrates improvement in freedom from metastasis as well as freedom from non-p...
How would you approach post-op radiation recommendations in patient who had neoadjuvant chemotherapy for locally advanced oral cavity cancers (oral tongue) who have a complete pathologic response (pCR) after surgical resection?
While randomized studies of induction chemo followed by local therapy compared with local therapy alone in the 90’s were all negative, it was clear that responding patients did better than non-responding ones. An example is a study (Licitra et al., PMID 12525526) of quite advanced oral ca randomized...
How would you manage a young patient with Sjogrens disease with extranodal marginal zone lymphoma involving bilateral parotid glands with bilateral cervical lymphadenopathy?
For patients with low-grade NHLs (e.g., follicular lymphoma, marginal zone lymphoma), staging dictates treatment. If a patient has a localized process (e.g., contiguous stage I-II disease), then a definitive course of RT is typically recommended. The conventional approach is 24-30 Gy, though a dose-...
What do you view as the optimal use and timing of cemiplimab in high risk CSCC?
Increasingly, neoadjuvant cemiplimab has become our preferred approach for many patients with resectable high-risk CSCC, and this is consistent with what several high-volume centers are now doing. The high pathologic response rates, durable recurrence-free survival in responders, and meaningful surg...
Would you continue cemiplimab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma treated with downstaging immunotherapy?
This is a challenging question because, as you know, we have no randomized data to address it. I generally do not continue immune checkpoint therapy after resection of SCC skin. However, given the adjuvant data in melanoma and the high efficacy of anti-PD1 in skin SCC, I do think it is reasonable to...
In a patient with a mid-esophageal squamous cell carcinoma with tracheal invasion confirmed on bronchoscopy, would you treat with definitive chemo-radiation with curative intent?
I generally start with chemotherapy alone in these patients, usually carbo/taxol for 2-3 months, and then re-evaluate with PET, bronchoscopy, and endoscopy to determine if there is still evidence of transmural invasion into the trachea. Often, if the tumor responds, the tracheal invasion is no longe...
How long after resection for brain metastasis do you wait to request a radiation planning MRI?
This is a good question, and I agree with the sentiments above. I think there are two competing issues here--1) evolution of the cavity and 2) regrowth of microscopic disease.While intuitively, one might think that waiting longer might allow the brain to normalize and the cavity to shrink, our data ...
How do you approach the treatment of LS-SCLC after SBRT for a prior NSCLC in the ipsilateral lung?
You know, it was so rare to see this in the first half of my career, and now I see it a few times a year. It's a testament to the improvements we are seeing in the care of lung cancer patients... they are getting 2nd cancers. Where I am (Mayo), we generally treat it exactly like an SCLC from the per...
Is there a role for quad-shot or similar regimen in a patient with a technically resectable, but medically inoperable colon cancer that is both bleeding and causing a partial obstruction?
I do not use quad shot for the palliation of gastrointestinal tumors. I do not believe in giving doses larger than 3 Gy per fraction because it uses up tolerance, and it's difficult to retreat. My strategy is to be able to treat the patient again after recovery of tolerance in a year. This usually r...