Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should we repeat a dose-escalation trial for stage III NSCLC in the era of modern radiotherapy techniques and dose constraints?
Yes to a study with modern techniques. The outcome was so odd that high dose was killing patients at a higher rate than with standard dose, despite many phase II and retrospective studies showing good outcomes. The subset analyses showing that IMRT was associated with better outcomes as well as more...
Would you alter your treatment algorithm for uterus mesonephric-like adenocarcinoma?
Very rare entity and would follow management principles for high grade (g3) endometrial cancer.
What radiation would you offer for isolated nodal recurrence in a patient who received APBI for breast cancer about 2 years ago after ALND?
If imaging is negative for IBTR, I would favor regional nodal RT only after dissection.
How do you handle the obturator prosthesis during radiation delivery for SCC of hard palate?
Leave it in if it’s not problematic.
How would you manage a Grade II IDH mutant astrocytoma with otherwise low risk features, but gemistocytic histology?
Not sure there is a right answer for this one - in general, for an IDH mutant grade 2 astrocytoma with low risk features, I would consider observation. If all else is low risk with the exception of gemistocytic histology, I may still consider observation and counsel the patient about an increased ri...
How would you approach a stage III NSCLC that is a biopsy-proven new primary located in the same field as a prior stage III NSCLC previously treated with chemoRT?
First, I'd need to know the interval since the previous course of radiation. If it was recent, this may simply be the growth of a resistant subclone. Next Gen sequence comparison can be helpful here. If the interval was >3 y, it may well be a new cancer. I would give the patient the benefit of the d...
How does residual DCIS after neoadjuvant chemotherapy impact prognosis if there is a CR of the invasive disease?
The majority of studies suggest residual DCIS has the same outcome as pCR with no invasive disease and thus is still treated as pCR in practice.
Would you consider pelvic radiation in a patient with prostate cancer and myelofibrosis with mild cytopenias?
I would avoid prophylactic RT in this scenario as the absolute benefit has to be weighed against the worsening of cytopenia.
How would you approach management of a patient who is status post resection of a WHO grade 1 planum sphenoidale meningioma which was adherent to the optic nerve?
As suggested by the mere fact of its posting, this is a complex question. If this were a gross total resection (GTR), I would tend toward observation and would follow the patient carefully with imaging and clinical evaluations at 6-month intervals for at least 3 years, then annually. GTR for a planu...
For an atypical meningioma WHO grade 2 s/p GTR, do molecular findings that suggest an integrated diagnosis of a grade 3 tumor change adjuvant radiation treatment recommendations?
There is no definitive clarity on this question, as the data simply do not exist. Therefore, decision-making has to be individualized. For residual disease, the GTV would be easy to estimate, but it might be prudent to utilize the pre-op scans in these patients to understand the pre-op GTV, which co...