Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How does surgical management of the ipsilateral cN0/pN0 neck with SLN vs standard neck dissection impact your adjuvant elective neck dose in oral cavity cancer?
Correct me if I am not interpreting the question correctly, but I infer that there is a primary indication for XRT, and the question relates to, since you need to treat the primary, what elective dose should the neck be prescribed, and how should it be determined to be N0 influence dose decisions? G...
Would you recommend ISRT for an initially bulky nodular lymphocyte predominant Hodgkin lymphoma with complete metabolic response after 4 cycles of R-CHOP?
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma. Approximately 95% of Hodgkin lymphoma cases are classified as classic Hodgkin lymphoma, including the nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted subtypes, all of which a...
When treating rectal cancer with TNT and induction chemotherapy first, do you repeat pelvic MRI prior to planning for chemoradiation?
TNT approach options for pMMR T3, N any; T1–2, N1–2; T4, N any or locally unresectable or medically inoperable rectal cancer patients include:First chemotherapy for 12-16 weeks (FOLFOX or CAPEOX may also consider FOLFIRINOX) followed by long-course chemoradiation or short-course radiation, followed ...
How would you approach adjuvant systemic therapy for an isolated, oligometastatic CNS recurrence of RCC that was treated with SBRT?
I tend not to treat patients with resected/irradiated CNS lesion(s) if there is no disease elsewhere. Such patients were not included in the adjuvant pembro study, the activity of any systemic therapy for CNS disease is not well-established, and in general, I worry single agent pembro is undertreatm...
Are there patients for whom CROSS followed by surgery and adjuvant nivolumab should still be considered, following data from MATTERHORN and ESOPEC?
ESOPEC does not invalidate CROSS—it redefines the preferred option for fit patients; in the real world, not every patient will be able to tolerate FLOT or d-FLOT: Yes. Despite the emergence of perioperative FLOT-based strategies from ESOPEC and MATTERHORN, CROSS, followed by surgery and adjuvant niv...
What dose of radiotherapy do you use for low volume Castleman's disease?
Reports in the literature are varied in terms of radiation dose. For scenarios such as this with low volume disease, it is probably reasonable to consider the lower end of ranges reported by others to be successful, such as 30 Gy. Careful pathology review is important for these cases as well. One mu...
How would you approach a triple negative carcinoma of the axilla with unknown primary and a CR after neoadj chemo followed by ALND?
Breast plus RNI excluding dissected axilla.
What dose constraint do you use for the spinal cord in the setting of re-irradiation?
Dr. Arjun Sahgal published the dose constraints in Red J.Reirradiation human spinal cord tolerance for stereotactic body radiotherapy.Sahgal A, Ma L, Weinberg V, Gibbs IC, Chao S, Chang UK, Werner-Wasik M, Angelov L, Chang EL, Sohn MJ, Soltys SG, Létourneau D, Ryu S, Gerszten PC, Fowler J, Wong CS,...
In light of the pending overall survival data and reported declines in quality of life associated with the PSMAddition trial, how do you envision incorporating Pluvicto into the management of mHSPC?
The PSMAddition trial was a phase III trial of [177Lu]Lu-PSMA-617 (i.e., Pluvicto) combined with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI) in patients with PSMA-positive metastatic hormone-sensitive prostate cancer (mHSPC). This trial randomized men with u...
What is the best treatment for radiation recall skin reaction of the breast?
History and distribution suggest radiation recall effect. If no agent which precipitated recall, can be ascertained then have done symptomatic management with a topical agent and follow up to see course (it subsides or gets better with time).