Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the appropriate role for radiation therapy in patients with HCC or intrahepatic cholangiocarcinoma who are transplant candidates?
Most HCC and cholangiocarcinoma patients who are transplant candidates are often also SBRT candidates. We have used SBRT to bridge patients to transplant. These patients often have had prior liver directed therapies such as MWA, RFA or TACE. There are no randomized trials comparing different liver d...
When using SBRT to treat unresectable pancreatic cancer after induction chemotherapy, do you treat elective lymph nodes?
Short answer - yes, we started doing this ~6 months ago.Longer answer: Our practice has changed here recently. Initially, when offering ablative radiation for locally advanced unresectable pancreatic cancer, either with 15-25 fractions on a conventional linac or with 5 fractions on an adaptive platf...
When do you refer patients back to their PCP for the predominant management of their medical care following completion of oncologic or BMT treatment?
Transitions of care are always challenging, especially for patients with complex medical histories, including cancer or stem cell transplantation. There are many different models for how and when to transition patients back to primary care or shared care. The ongoing, often complex needs of survivor...
What's the role of contralateral neck re-irradiation in the post-op setting for someone with a remote history of head and neck cancer who underwent definitive RT with elective dose to the bilateral neck now with a new primary s/p surgery with ipsilateral neck dissection requiring post op chemo radiation for bony involvement and ENE?
In a reirradiation setting, I would not offer elective RT. Even if the new primary approached or crossed midline, I would refrain from reirradiating a neck that was subject to prior RT in the 50 Gy range.
For an upper lip (near midline) Merkel cell carcinoma s/p wide local excision with negative SLNB and no adjuvant RT, with the recurrence to one side of the neck a year later, should the contralateral neck be included in the radiation field?
Our practice for metachronous isolated neck metastases one year or more after primary treatment is to treat only the involved neck with the rationale that there has been adequate time for the cancer to declare itself. This presumes the contralateral neck is screened with US and PET-CT, and then woul...
Would you consider a third course of radiation to the same site for late lung cancer in-field recurrence?
Here are my thoughts: Where the recurrence is relative to surrounding OARs is critical. For example(s): A peripheral pulmonary nodule near the chest wall and lateral to the central structures, plexus, cord, etc with surrounding fibrosis from prior treatment is a much safer bet for re-re-treatment....
What is your approach to definitive RT for nasal vestibule squamous cell carcinomas?
I would use IMRT. For N0, I would treat at a minimum levels 1B, 2, and the in-transit facial lymphatics that used to get included in the traditional "moustache field". These in-transit lymphatics have been designated as level IX in the 2014 consensus nodal guidelines. For node-positive, I also treat...
Do you consider induction immunotherapy or chemoIO prior to chemoradiation for locally advanced PDL-1> 50% NSCLC if normal tissue constraints are not met?
If normal tissue constraints can't be met, or significantly higher chance of distant metastatic disease due to extensive local/regional disease, I would consider induction chemo/IO for patients with negative EGFR, ALK mutation and PD-1>1% before definitive chemo/RT in inoperable stage III NSCLC. Thi...
How do you manage early stage I uterine serous carcinoma?
The management of these patients remains controversial. The data are conflicting and treatment choices tend to be based more on impressions than solid data. Most clinicians advocate chemotherapy although randomized trials have not clearly shown benefit for this subset. For stage IA, we typically tre...
Would you offer a third course of palliative radiation after two courses of 8 Gy in 1 fx?
Hip pain can mean different things - is it the ilium, ischium, acetabulum, femur, or L-spine causing the pain?If it is the exact same bone as previously treated, a third fraction of 8 Gy can generally be safely given over the course of 4 years, especially if pain relief each time has lasted ~2 years...