Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat rectal squamous cell carcinoma the same as rectal adenocarcinoma, stage for stage?
No, I will treat rectal squamous cell carcinoma the same as anal squamous cell carcinoma, with definitive chemoradiation with 5FU/mitomycin. If the cancer invades the posterior vaginal wall or prostate, I will also include external ilac nodes. If the tumor involves lower rectum/anus, I will also tre...
For a patient with IIIC1 (micromets), MSI-high, Grade 2 endometrial adenocarcinoma who has undergone full surgical staging, do you recommend adding immunotherapy to adjuvant chemotherapy + radiation?
Short answer: No, I do not recommend adjuvant CT/IO + RT for this patient based on the patient's risk factors in the prompt, and the data below. Should the patient have recurrent/metastatic disease following adjuvant CT + RT/VCBT, then I/O + CT is a good option. Ongoing trials hope to answer this qu...
For a patient with locally current endometrial cancer whose disease had complete radiographic response to carboplatin, Taxol, and pembrolizumab, would you consider adding radiation therapy?
Despite having a complete response to chemoimmunotherapy, I would tend toward adjuvant RT since this was a local recurrence. We don't have long-term data with chemoimmunotherapy in this locally recurrent setting.
Would you consider repeat lumpectomy and external beam partial breast reirradiation for in-breast recurrent cancers?
Patients experiencing a localized recurrence in a breast previously treated with lumpectomy and whole breast radiation are appropriately offered salvage mastectomy with or without reconstruction as an acceptable standard. However, many patients wish to have options that preserve the breast. Repeat l...
How should dose homogeneity across bone be handled in pediatric patients?
The radiation-associated bone damage can be affected by many factors, including total radiation dose, fractionation schedule, treatment volume, age of the child, symmetry of the delivered dose over vertebrae, developmental status of the irradiated growth plates, treatments such as chemotherapy or su...
Do you treat elective nodes in unresectable pancreas when treating with 15fx?
No, the standard has been to include only grossly enlarged node, so for now we do not include elective nodal irradiation. We will re-evaluate this practice when we have more data and are better able to assess the pattern of disease progression. We are treating over 100 cases a year uniformly, so thi...
When would you offer post-op radiation for the treatment of sebaceous carcinoma of the eyelid?
I think of them as poorly differentiated and it’s a location where margins are likely close so always.
How do you manage a head and neck cancer patient with the presence of high grade dysplasia at a margin?
This is an excellent question. According to some pathological literature, a margin positive for in situ carcinoma or high grade dysplasia has a similar recurrence risk as a frankly positive margin with invasive disease. NCCN guidelines define carcinoma in situ or invasive disease as a "positive marg...
In clearly resectable pancreatic adenocarcinoma with no arterial or venous involvement, is there a role for neoadjuvant chemotherapy?
There is currently equipoise regarding this question, and the Alliance A021806, a phase III trial evaluating perioperative versus adjuvant therapy for resectable pancreatic cancer, clinical trial will address it. There is a role in certain subsets of patients without clear vascular involvement regar...
Should special precautions be taken patients with Ehlers-Danlos syndrome receiving radiation therapy?
Not all EDS is the same. Most commonly, an EDS patient these days is a clinically diagnosed patient with hypermobile joints, possibly stretchy skin, and possibly chronic pain syndrome. That is a very different picture from vascular EDS with a COL3A1 mutation, which is rare and would have the extreme...