Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer adjuvant radiotherapy for pancreatic adenocarcinoma following surgical resection?
Unfortunately, the data on adjuvant radiation therapy is not answered. Most of the randomized studies (such as the flawed ESPAC study) do not show a definite advantage to RT (or even a disadvantage), and the non-controlled studies tend to be positive. There are a few things that we can say with some...
When treating pancreatic cancer with adjuvant chemoradiation, do you treat the initial field to 50 Gy, as per RTOG 0848, or to 45 Gy?
What I do: R0: 50.4 Gy in 28 fractions 3D CRT with a field reduction at 45Gy off of the jejunal reconstruction as much as possible The 45Gy goes to the SMA, Celiac, porta and tumor bed. R1: (path says margin <1mm or postive, no soft tissue near SMA in CT): Boost to 54Gy with 3DCRT. R2: Gross disease...
Within what timeframe should adjuvant radiotherapy start for Merkel cell carcinoma of the head and neck region?
I use a 4-6 week post-op timeframe for adjuvant RT for Merkel cell carcinoma. I always prefer closer to 4 weeks, whenever possible.
Is 80 Gy/40 Fx + ADT the new standard of care for definitive radiation of high risk prostate cancer?
For those who want a more thorough answer, enjoy. If you want you can skip to the end for the summary: For well over a decade, we are taught that dose escalation improves biochemical control but not overall survival, while ADT improves both. Do the results of GETUG AFU-18 change this? Let's take a l...
How would you manage a young patient with Sjogrens disease with extranodal marginal zone lymphoma involving bilateral parotid glands with bilateral cervical lymphadenopathy?
For patients with low-grade NHLs (e.g., follicular lymphoma, marginal zone lymphoma), staging dictates treatment. If a patient has a localized process (e.g., contiguous stage I-II disease), then a definitive course of RT is typically recommended. The conventional approach is 24-30 Gy, though a dose-...
When selecting mCRPC patients for Pluvicto, which baseline variables do you find most useful or predictive of potential hematologic toxicity?
One important consideration in the recommendation of Lu-177-PSMA radiopharmaceutical therapy (RPT) is an assessment of a patient’s marrow reserve, as hematologic toxicity is one of the most common clinically relevant toxicities after such treatment. Important clinical features to help assess the lik...
Would you consider neoadjuvant immunotherapy prior to radiation for a locally advanced skin squamous cell carcinoma?
While the definitive trials are yet outstanding and enrollment in NRG HN0014 (NCT06568172) should be encouraged where it is open, the present indications for using cemiplimab should follow its principal indication, unresectable cutaneous squamous cell cancer, a minority of cases at 5%. Practically s...
Would you offer hypofractionated PMRT to a pathologic T2N1a BRCA positive patient?
I would irradiate this patient due to the combination of a positive node and LVI, regardless of her age. I define "young" as age 40 years or younger; others use age 35 to 45 as cut-offs. It's not clear what this patient's age is based upon the information given.All of the data to date from randomize...
Are you offering hypofractionated comprehensive nodal irradiation following neoadjuvant chemotherapy for patients with locally advanced breast cancer in the setting of COVID-19?
In locally advanced breast cancer following neoadjuvant chemotherapy, we are offering hypofractionated radiation to the breast and regional nodes, and flat chest wall and regional nodes. In these cases, I treat to 40 Gy/15 fractions. For nodal coverage, I like to see 38 Gy line covering nodal basins...
What dose constraints do you use for hypofractionated radiotherapy for breast cancer undergoing regional nodal irradiation?
I offer hypofractionated treatment with RNI for patients following lumpectomy or mastectomy without reconstruction off trial. In those patients, in terms of constraints, I have typically used the Alliance trial hypofractionated arm constraints.