Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer adjuvant radiotherapy for a malignant fibromyxoid tumor of soft tissue with margin < 1 cm on re-excision?
Malignant ossifying fibromyxoid tumors are very rare and from a pathologic perspective, often get lumped under the tumors of intermediate malignant potential and of uncertain differentiation category. The expectation that the histologically malignant fibromyxoid tumors behave malignant, and thus I w...
Is morphea, cutaneous scleroderma, with no organ involvement a contraindication for radiation in early stage breast cancer as part of breast conservation therapy?
I am not sure anyone can answer this question with a solid yes or no answer. The information we have about limited scleroderma and radiotherapy is for, lack of a better term, limited. We can draw from some experiences to guide the thought process. In one large series of patients from two scleroderm...
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...
What is your approach to TNT sequencing for locally advanced rectal primaries with low volume metastatic disease to liver?
This is a very common clinical scenario for which I'm not aware of a single correct answer. I assume by "low volume" metastatic disease to the liver the question implies potentially curable through some combination of liver-directed therapies. The only part of the sequencing about which I am fairly ...
What would you offer postoperatively for a pt with resected 3 separate HPV+ SCC primaries with pN1 disease with ECE who is cisplatin ineligible?
In view of this patient having ECS and three primaries (including bilateral disease), I would definitely treat postoperatively with chemotherapy in conjunction with radiation therapy. I still favor a platinum-based regimen in view of this patient's neurological toxicity due to previous cisplatin exp...
What is your approach in deciding on definitive therapy for locally advanced, HPV-negative head and neck cancer unsuitable for standard cisplatin based chemo?
The real answer is it depends on the medical oncologist as (s)he typically administers the therapy.It also depends on why cisplatin is contraindicated. Is it an otherwise healthy patient who has renal or hearing issues, or is it an elderly patient with a marginal PS for whom cytotoxics, in general, ...
What are your top takeaways from ASCO GI 2026?
GLP1 agonist use is associated with improved outcomes for colorectal cancer in a retrospective United States study. Now we need to incorporate this into randomized trials. I think this also provides more evidence that metabolic syndrome type issues may help explain early-onset colorectal cancers. W...
Are there any special radiotherapy considerations for women who have double lumpectomy?
Z11102 looked at multiple ipsilateral breast cancers and lumpectomies. For these cases, I would be fine with hypofractionated WBI. Boost would be based on features of each cancer so if it was otherwise low risk for both, I would omit boost vs. if both were higher risk (< 50, ER-), I would boost both...
Do you use minimum cutoff values for any PFTs below which you would not offer conventionally fractionated chemoradiation or SBRT for NSCLC?
We have historically not used a cut-off lower-limit for FEV1 or DLCO when selecting patients for SBRT for stage I NSCLC. This is supported by both our own (PMID 19487961) and the Indiana University (PMID 18394819) series in which patients were divided into quartiles by baseline PFT's. In both series...
How important is a severely diminished diffusion capacity in determining whether to offer a lung cancer patient radiotherapy?
Conventionally, Pulmonary function tests (PFTs) are considered essential before considering thoracic surgery and by extension this rule has applied to definitive radiation. This is because baseline pulmonary function (PF) can predict the risk of pulmonary complications after thoracotomy, and patient...