Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you need renal biopsy before SBRT for RCC suspicious cancer?
Yes. The teaching is usually that ≈ 20% of small renal masses (<4 cm) are benign, and this rate goes down as size increases (Thompson et al., PMID 19286217). Features such as contrast enhancement, tumor location, and sex can help to improve the malignant risk potential of these lesions, but no combi...
Do you offer consolidation chemotherapy prior to durvalumab in locally advanced, unresectable NSCLC?
I do not offer consolidation chemotherapy to patients prior to durvalumab in patients with locally advanced, unresectable NSCLC. The PACIFIC trial was a randomized phase III trial that established the role of consolidation durvalumab after definitive chemoradiation for patients with stage III NSCLC....
How would you manage treatment of keloid that is so large it requests a graft?
16 Gy/4 fractions
Does postoperative radiation within 24 hours of a skin graft with a keloid resection increase the risk of graft failure?
The amount of radiation required to prevent keloid recurrence after excision is lower than what would be expected to compromise a skin graft. The studies cited are dealing with postoperative radiotherapy for cancer, where radiation doses are required to be higher than what is used for a keloid, and ...
How does positive peritoneal washings factor into your treatment decisions regarding pelvic radiation and/or chemotherapy?
At this point, for patients who lack other adverse factors, we do not change management based on positive cytology for endometrioid histology.
What is your preferred treatment for non-contiguous Stage IIA Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL)?
Prognosis of patients with early stage NLP-HL is excellent with any treatment, and multi-institutional studies have shown 5-year survival rates of 98% (Michael S. et al. Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG. Blood 2020; 13...
Should hydroxychloroquine be stopped prior to standard or hypofractionated breast treatment?
We don’t stop hydroxychloroquine for RT.
Would you use adjuvant hypofractionation (15-20 fractions) after BCT with negative margins for a patient with malignant phyllodes tumor?
We conventionally fractionate all our phyllodes patients given there is really no data currently (that I’m aware of) that supports hypofractionating this uncommon disease entity.The Dartmouth-led series studied patients using conventionally fractionated radiation.Barth Jr. et al. PMID 19424757Their ...
Could patients with smIPI >1 and poor tolerability to R-CHOP be offered ISRT after 3 cycles of R-CHOP if interim PET showed 5-PS 1-3 response?
The revised NCCN guidelines largely reflect data from studies demonstrating excellent outcomes with four cycles of R-CHOP in patients with low-risk diffuse large B-cell lymphoma (DLBCL), including FLYER, LYSA/GOELAMS, SWOG S1001, and the most recent trial, LNH2009-1B. Although each of these trials e...
How does a negative PSMA PET change your management when completing salvage radiation for prostate cancer?
It's important to remember that if patients are being referred early for salvage RT, most of them will have negative PSMA PET/CTs (< 50% are positive if the PSA is < 0.5). So, in these cases, you are relying on the usual factors to decide on treatment fields, dosing, and the use of ADT, including ot...