Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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 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 ...
How do you assess whether a patient is suitable for prostate SBRT?
At UCLA, we do not routinely use a prostate volume/size threshold when considering whether a patient is a good candidate for SBRT or not. There are data from the Georgetown group that suggest that men with prostate volumes ≥50 cm3 may have slightly increased acute grade ≥2 GU toxicity; these res...
How do you treat inoperable T1-2N0 apical lung cancers near the brachial plexus but without extension outside the lung?
This is a challenging question, and there are certainly a range of reasonable answers. I would agree with @Dr. First Last that the Forquer/Timmerman paper establishes there is significant risk of plexopathy when exceeding 24-26 Gy in 3 fractions. On the other hand SBRT offers superior local control ...