Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach adjuvant radiation recommendations for low-risk endometrial cancer in which the patient was unable to undergo pelvic sentinel node mapping?
Nodal assessment would not change much for me, as it’s a low-risk disease, and PORTEC data have shown the risk of nodal recurrence is low. For focal LVSI, one may consider brachy alone.
Do you offer hypofractionation or RNI for a pT1N0 high-grade primary neuroendocrine carcinoma of the breast?
Hypofractionation with a boost, yes. No RNI if the SNLN is negative.
Would you ever re-irradiate the groin/inguinal region?
I have done this for palliation. One can also consider hyperfractionation if the patient is expected to live longer.
Would you give durvalumab consolidation to a patient with stage III NSCLC with an STK11 mutation?
Short answer: I would.Longer answer: We certainly know that STK11 mutations are associated with worse outcomes with immunotherapy. There are very few data sets and no large datasets that I am aware of that specifically look at this subset of patients with regard to chemoradiation followed by durvalu...
Is SBRT an appropriate first line treatment for oligometastatic renal cell carcinoma?
When oligometastatic disease is a spinal metastasis it would be appropriate. True oligometastatic spine renal cell ca is exceptionally rare, and in the setting of solitary spine metatases where an en bloc resection is a very morbid surgery, our practice would be to offer 24Gyx1 rather than operate, ...
Given the updated results of the PREOPANC study, how can gemcitabine-based neoadjuvant chemoradiation be best incorporated into the treatment of resectable or borderline resectable pancreatic cancer?
The PREOPANC-1 trial and the study by Jang et al., PMID 29462005 are currently the only 2 published randomized trials comparing pre-op CRT vs up-front surgery for resectable/borderline resectable PDAC- each of which has now demonstrated an overall survival benefit. The obvious critique is the standa...
How would you approach a patient with a primary splenic DLBCL who has residual PET avid disease after 6 cycles of R-CHOP?
The treatment of DLBCL arising in the spleen would be very similar to the treatment of DLBCL at most other sites. After a full course of chemoimmunotherapy, if the patient has not achieved a complete response by PET-CT (Deauville 1-3), then the treating physicians need to make a judgment. The primar...
Would you hold cabozantinib for radiation therapy, or is concurrent use safe?
Cabozantinib is a VEGFR-TKI which potentially carries a risk of hemorrhage and bowel perforation when given together with high dose RT or SBRT though, tangible data are lacking. We will typically hold the drug for 3 days before starting SBRT and will resume 3 days after SBRT (not evidence-based).
Would you consider eliminating PMRT to the chest wall in select cases of T3N0 breast cancer?
There are a number of studies, including the one below, that suggest that favorable ER/PR+, HER2 negative patients with T3N0 have low local recurrence rates without PMRT. Every case is individualized and should take into consideration all factors including size, margins, and other adverse features b...
How would you mange true anal margin squamous cell carcinoma (with no involvement of anal canal) if wide local excision cannot be done and chemoradiation therapy is being used instead?
There are many facets to this question. First, it is critical to know that this is a surgical disease, and radiation therapy should only be used as a last resort. If there is no involvement of the anal canal, that strengthens the argument for the use of surgery. The situation is rare when radiation ...