Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you recommend patients get vaccinations with respect to their RT course?
I agree with @Dr. First Last's reply, and find that some patients are under the impression they are immunocompromised during radiation therapy and thus should avoid vaccines, when in fact the opposite is true. The skepticism behind the science of vaccination also can lead to avoidance, and so I try ...
Do the results and approval based on ADAURA trial suggest a role for adjuvant osimertinib in patients with stage IIIB-C, EGFR mutant patients treated with concurrent chemoradiation?
ADAURA trial was not designed to address this issue. But that being said, we need to remember few things before considering "maintenance durvalumab" in patients with EGFR-mutant lung cancer, following chemo-radiation: 1. EGFR-mutant NSCLC patients may not derive any clinical benefit from single-agen...
Would you offer APBI to a patient with very large breast anatomy and a small lumpectomy cavity after an oncoplastic closure?
I would offer it with the caveat I always offer APBI candidates which is that final suitability will be determined at sim to ensure the surgical bed is evident and suitable for APBI. The breast surgeon will mark the tumor bed with clips and if the closure hasn't disrupted or dispersed the clips, APB...
Would you consider a third course of radiation in a patient with a WHO 3 astrocytoma who has previously received a fractionated course followed by fSRS many years later?
After a long interval such as 10 years, some recovery of normal brain tolerance is believed to occur, although the degree of recovery is not precisely known. Many radiation oncologists assume partial recovery of approximately 50-70% of prior tolerance when estimating reirradiation safety, but this i...
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
ILROG recently came out with guidelines pasted below: Synopsis of ILROG Recommendations for Administering Radiotherapy for Hematological Malignancies During Emergency Conditions of the COVID-19 Pandemic • We are facing an increased demand for RT to substitute or complement systemic therapy deemed i...
Is there a role for induction chemotherapy for locally advanced head and neck squamous cell carcinoma prior to definitive chemoradiation?
Induction chemotherapy can be considered in some patients with locally advanced SCCHN, primarily those patients with large bulky tumors who are at highest risk for developing distant metastases. Moreover, if you are looking to attain reduction in tumor bulk for symptom control and possibly control o...
How do the results of LIBRETTO-432 shape the potential role of adjuvant selpercatinib in patients with early-stage RET fusion-positive NSCLC?
The results of LIBRETTO-432 provide strong evidence to consider selpercatinib for patients with stage II-IIIA RET fusion-positive NSCLC, with a highly significant HR of 0.172 (0.058-0.59) for this cohort. When thinking about stage IB (tumors 3- 4 cm, T2b), most of these patients were not included in...
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...
Is it necessary to treat one vertebral body above and below for palliation of spinal metastases?
No. The reasons to go one above & below were to avoid the dreaded miss from the dreaded days of bone scans, plain films & port films. That is much, much less likely these days with IGRT, CBCT, MRI (PET, etc.). We know treatment volume size correlates with toxicity. You can get some dysphagia/esophag...
What are best practices for radiation oncology patient and staff precautions with the COVID-19 pandemic?
COVID Update 1/30/21 Wow, it's been almost a year. Here are some updates from our practices at University of Maryland. We have successfully treated both PUIs and COVID+ patients at all of our practices. We have yet to have a patient to staff (or staff to patient) transmission. We do not break patien...