Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should hippocampal-avoidance WBRT be the default option for WBRT?
I think this is a difficult question to answer as a lot depends on the particulars. Here's a list of some of those issues: Radiosurgery is very easily administered & frequently free of toxicity. Systemic agents are showing improved efficacy in the brain. Surveillance MR imaging = lower incidence of ...
For an non-operative patient with IB1 cervical cancer, would you recommend RT alone or concurrent chemoRT for definitive therapy?
I usually favor RT alone as local control and the outcome is excellent unless they have adenocarcinoma, a suspicious pelvic node, or multiple high risk features (high grade with LVSI on bx).
Would you use a hippocampal sparing technique when treating with PCI for a limited stage small cell lung cancer?
This is an important question where the evidence is evolving, and some key trials remain ongoing. Because the data remains in flux, in the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- prophylactic cranial irradiation (PCI) for LS and ES-SCLC, where I serve as the PI, hippocampal...
Do you omit PMRT for patients who would have been eligible for NSABP B-51, but are found to have significant pure LVSI only, without stromal carcinoma, after neoadjuvant chemotherapy?
I would treat it like a partial response and favor RT.
How would you manage a small posterior vaginal defect noted at the time of cervical brachytherapy?
If it is from a disease, I would continue brachy as planned and address the defect based on response and healing. If unrelated to disease, I would have it sutured and continue brachy as planned.
Would you continue cemiplimab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma treated with downstaging immunotherapy?
This is a challenging question because, as you know, we have no randomized data to address it. I generally do not continue immune checkpoint therapy after resection of SCC skin. However, given the adjuvant data in melanoma and the high efficacy of anti-PD1 in skin SCC, I do think it is reasonable to...
Do you recommend IM biopsy in the initial staging of breast cancer patients with suspicious IM nodes on imaging?
I think it is always preferable to biopsy suspected cancer sites when developing a therapeutic plan. Biopsy provides a greater degree of certainty in clinical decision making and can be informative when evaluating outcomes of care retrospectively for quality improvement or research projects. However...
For post-prostatectomy radiation, are there any special considerations if there is a bladder sling or artificial urinary sphincter?
Radiation after a bladder sling or a urinary sphincter can be done, and in my experience is mostly done without major complications. I have done it several times, and I am not aware of any significant problems. There are no prospective studies or randomized studies of which I am aware that can help ...
How long can you delay the start of radiation in a patient who has received adjuvant chemotherapy after lumpectomy/mastectomy?
I generally start radiation between 3 and 8 weeks following the last dose of chemotherapy. Since most protocol guidelines specify radiation should start within 12 weeks of the last day of chemo is within the last surgical procedure, I use that as an outside window I am comfortable with for the most ...
Do you still routinely offer post-op radiation after bone fixation?
I'm a little nervous about the phrasing of the question as it implies that there is an ongoing evolution in practice here. I don't think there is. To emphasize, PORT is--and remains--the standard of care following orthopedic stabilization of bony metastases: Alcorn et al., PMID 38788923Now, it is fa...