Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach PORT for T3N0 NSCLC, which had chest wall invasion, now status post lobectomy with a microscopically positive margin?
PORT should still be offered/considered for R1 resection such as this T3N0 patient. It sounds as if this person, or someone in a similar scenario, would have been served well to have undergone NACT to help achieve R0 prior to surgery. But nonetheless, I would take the following approach (assuming ap...
Would you recommend adjuvant breast radiation following lumpectomy for a well-differentiated adenoid cystic carcinoma that appears to be a breast primary?
For an adenoid cystic carcinoma of the breast treated with breast conserving surgery, I would recommend adjuvant radiotherapy after BCS. Though data are limited, there are both a SEER analysis and RARE cancer network study that demonstrate an advantage to radiotherapy following conserving surgery. I...
How do you treat locally advanced, operable, Siewert 3 GE junction adenocarcinomas?
This remains an area of controversy, but perhaps not as controversial as Siewert type II tumors. Siewert type III tumors are staged as gastric cancers in the AJCC 8th edition. In addition, they are more histologically similar to gastric cancer and have patterns of nodal spread like gastric cancer as...
How aggressively do you approach pelvic treatment for patients with low volume metastatic cervical cancer, but bulky local disease?
For patients with minimal oligometastatic disease, for example, a single lung metastasis or a supraclavicular node, we will often treat all sides definitively. For patients with more significant metastatic disease, we would consider treating the primary with a shortened course of radiation. For exam...
Under what circumstance do you offer a definitive approach to local treatment of a patient with oligomestastatic cervical cancer found on initial staging PET/CT?
FIGO stage IVB Cervical CancerCervical cancer spreads in an orderly fashion predominantly via the lymphatic system and subsequently hematogenous spread to the lung and elsewhere.The FIGO stage IVB cervical cancer includes those with distant nodal metastases (para-aortic or supraclavicular lymph node...
What are the risks of treating locally advanced pancreatic cancer with chemoradiation with duodenal stent in place due to malignant obstruction?
There is no increased risk from radiation treatment when a duodenal stent is in place.
What are your target volumes for treatment of a hemorrhagic brain metastasis with SRS?
If this is an unresected hemorrhagic brain metastasis, I would consider covering hemorrhage while taking into account my RT volume. There is data showing that hemorrhagic brain metastasis is associated with inferior local control/outcomes vs. non-hemorrhagic brain metastasis after SRS (PMID 29936319...
Would you treat endometrioid adenocarcinoma arising from an endometriosis lesion in a patient with prior hyst/BSO like an ovarian or endometrial primary?
For a patient with prior hyst/BSO and now an endometriosis-associated endometrioid adenocarcinoma, I would start by getting next-generation sequencing and MSI/MMR testing of the tissue specimen that was used to make the diagnosis. This would allow for additional information and the potential use of ...
Would you offer PMRT when the only indication is a focally positive margin?
If this is the only indication (T1-T2N0 and no other risk factors like LVSI, high-grade disease, triple negative, etc.), then would consider only if the patient was younger (<50 years old). It appears these patients have a much higher rate of recurrence than older patients and chest wall-only RT is ...
How do you approach small bowel constraints in the setting of reirradiation?
This is a very tough question to answer. I agree with Dr. @Dr. First Last's answer.The maximum dose for the small bowel during reirradiation can vary depending on various factors such as the previous dose received, the interval between radiation treatments, the purpose of reirradiation (palliative o...