Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a nodal recurrence of cutaneous SCC if the patient is unable to receive surgery for 6-8 weeks?
I’d first consider referring the patient to a center that could perform the operation, as it is standard of care for a patient with resectable cSCC with nodal metastases. At some centers, there may be a clinical trial of neoadjuvant immunotherapy that could be considered. If those options were not...
Would you consider radiation therapy for prostate cancer in a patient with osteogenesis imperfecta?
I would use a modality to reduce dose to bone as much as possible and would favor brachytherapy if feasible as this would give the least dose to bones.
How would you manage a patient with favorable intermediate prostate cancer patient who obtains a high Decipher test score at the end of their RT course?
Would favor adding 4-6 months of ADT.
How do you deal with an interruption in definitive EBRT for prostate cancer?
The evidence that total treatment time matters in prostate cancer is pretty weak. In general, I would proceed as planned when the patient is able to resume without increasing the intended total dose. In this case, I would prefer not to stop at 60 Gy, as that dose probably would not be curative. Unle...
How do you approach staging and treatment for a p16+ nasopharyngeal SCC?
First question is whether it is strictly p16 positive and confirmed EBER ISH negative. If so, I treat it like p16 positive oropharyngeal cancer with chemoradiation. I don't give adjuvant chemo. All the adjuvant chemo or induction chemo data is for EBER ISH positive nasopharyngeal carcinoma.
Would you offer post-operative radiation therapy for a pseudoendocrine sarcoma with a CTNNB mutation of the spine that has been resected with a positive margin?
I am not aware of any histology-specific data that would alter the otherwise standard approach to such a situation. If I were seeing such a patient, I would: Get MRI to confirm no gross residual disease. Ask the surgeon to re-resect for R0 margins, if at all possible. Treat to 60 Gy postop if so, ...
Would differentiating between embryonal vs alveolar rhabdomyosarcoma of the nasal cavity change your neoadjuvant chemotherapy regimen or make you consider neoadjuvant radiation in a locally advanced pleomorphic RMS?
The historic Embryonal vs. Alveolar differentiation is being replaced by a (PAX-FOXO) fusion positive vs. negative classification given the prognostic significance. In either case, the chemotherapy regimen is not likely to change in an adult patient. Pleomorphic RMS on the other hand, more common in...
When, if ever, do you recommend concurrent chemotherapy with definitive RT for early stage oral cavity squamous cell carcinoma?
Early stage oral cavity cancers are best treated with surgery or definitive RT including brachytherapy. If brachytherapy is not feasible and surgery is not an option, I would consider adding cisplatin but it would not be my first choice.
How would you treat an isolated pancreatic adenocarcinoma recurrence in the post-op bed with progression through chemotherapy and no prior radiation therapy?
These tumors can usually be treated more easily with definitive doses of radiation because the duodenum has been removed. We are presenting our 69pt experience treating isolated local recurrence with ablative doses at ASTRO this year. Doses: 100Gy BED, (50Gy/5#, 67.5/15#, or 75Gy/25#). Median OS: 26...
What radiation lung dose constraints should be used for a standard fractionation plan in patients recovering from recent immunotherapy induced pneumonitis?
Since immune mediated pneumonitis tends to be a more global/diffuse process, I'm much more concerned about low dose spillage throughout the lung. IMRT is so commonly used for treating lung cancer so we often forget that trying to minimize low dose spillage (i.e. V5) may be better accomplished throug...