Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In rectal cancer patients receiving total neoadjuvant therapy, do you prefer chemotherapy followed by long-course chemoradiation, or short-course RT followed by chemotherapy?
We now have level 1 evidence showing the superiority of a few TNT regimens over standard chemoradiation->surgery->chemotherapy for these patients. There are going to be some stage II/III patients where TNT is overtreatment (ie, may be able to avoid the chemotherapy, radiation or surgery), but that c...
Is it safe to use doses of 3Gy in a BID treatment for palliative urgent cases?
This combination of a "hypofractionationated" 3 Gy dose per fraction with a "hyperfractionated" BID schedule has been described in the setting of "quad shot" radiation- most typically associated with head and neck cancers. The goal is to provide robust palliation within a short time frame. The "quad...
Are the results of CONKO-007 changing practice for the management of pancreatic cancer?
The results of CONKO-007 are exactly as expected. The clinically relevant endpoint of OS was not improved with the addition of chemotherapy. These results are similar to the PREOPANC-2 trial in BRPC. Since definitions are rarely followed in practice, BRPC and LAPC populations have merged over time; ...
What are the implications of a VP shunt located in the radiation field in a patient receiving treatment for breast cancer?
I don’t see any contradiction to RT here.
What is the appropriate dose to the dissected node-negative neck with indication for radiation due to advanced primary?
60 Gy/30 fractions if HPV negative. 50 Gy/25 fractions or equivalent if HPV-positive OPX.
What is your approach to nodal coverage in a patient with lateralized adenoid cystic carcinoma (ie., buccal mucosa) with positive lymph node(s)?
I would cover the ipsilateral neck and named nerve to at least the foramina at the skull base.
Will you wait to simulate, or resimulate, a patient after teeth extractions in preparation for HN cancer treatment?
The answer is, it depends. I do not have a specific policy, and it depends refers to which and how many teeth need to be extracted. The main questions to answer this question are: Will the extractions alter the set up? And as a corollary, will the extractions alter the use of an intraoral device? A...
How would you manage an elderly patient with a de novo TNBC in the setting of a remote prior ipsilateral breast cancer s/p mastectomy and implant?
Unusual case: Looks like a new primary based on the timeline and presuming repeat SNLN was done and is negative. If local treatment is adequate as above, one can skip RT. Otherwise, I would favor RT. Also, obtain BRCA testing.
Should the hemorrhage be included in the volume when treating brain mets with SRS?
Having seen hemorrhage around brain metastases which later resolves, revealing uninvolved parenchyma, I do not include extralesional hemorrhage in the target volume when treating brain metastases with SRS. In patients for whom the edges of metastases are obfuscated by blood, I tend to favor whole br...
Do you recommend adjuvant radiotherapy for an adult patient with localized myxopapillary ependymoma, WHO Grade 2, status-post gross total resection?
I assumed that this is a case of spinal ependymoma. Myxopapillary ependymomas are rare tumors and optimal therapeutic strategy involves a Gross Total Resection (GTR). The more complete the surgery the better the outcome. The role of postoperative radiation after a GTR is somewhat controversial but I...