Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach a patient with indolent, small-volume, but slowly progressive lung mets from sarcoma?
If small volume without active extrapulmonary disease and amenable to addressing all lesions with SABR, surgery, or a combination of both, I would target all lesions with local therapy. If the above conditions are met, these can often be monitored closely with q3-6 month CT surveillance in the prese...
What are best practices for taking care of lung cancer patients during the COVID-19 pandemic?
This is a great question, and as always there is no one size fits all. For patients on active treatment for lung cancer such as chemoimmunotherapy, I continue to stress the importance of hand washing, social distancing, and to work on reducing wait times in the waiting room to limit exposure, etc. I...
In the era of NSABP B51, how do you approach patients with occult primary who achieve a pCR in the nodes?
One can go either way, but would look at pre-chemo phenotype, nodal size, nodal number and location, and if any one of them favors RNI along with breast RT.
How would you counsel a patient concerned about receiving IMRT rather than IMPT for oropharyngeal cancer?
I would tell the patient there is absolutely no concern at all with IMRT, and it is a very well-established SOC. I am personally unclear about the OS benefit with IMPT, as it was pointed out, unexpected. It is unusual to see no difference in PFS and no tox difference, and yet there is an OS differen...
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Would you ever consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response?
Yes, I would consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response.Data of 655 melanoma patients treated in pembrolizumab phase 1 KEYNOTE-001 study has shown 95 patients (14.5%) achieved CR after a median follow-up of 32 months. Treatment was discontin...
Would you offer PMRT to a patient with pTisN1a left breast DCIS?
Macrometastases suggest there is missed invasive disease in the midst of 11-cm DCIS. For one macromet with only SLNB done, I would add CW and RNI as part of treatment, but if I had an ALND, then RT can be avoided.
For an upper lip (near midline) Merkel cell carcinoma s/p wide local excision with negative SLNB and no adjuvant RT, with the recurrence to one side of the neck a year later, should the contralateral neck be included in the radiation field?
Our practice for metachronous isolated neck metastases one year or more after primary treatment is to treat only the involved neck with the rationale that there has been adequate time for the cancer to declare itself. This presumes the contralateral neck is screened with US and PET-CT, and then woul...
How would you manage the side effects/toxicities (e.g., pain, swelling, erythema) of adjuvant EBRT to the ear for cutaneous SCC?
I have had a few patients experience acute pain in the ear canal, probably from inflammation, wet desquamation, and bacterial overgrowth. Ciprodex Otic drops x 7-10 days have been helpful.
In the wake of the COVID-19 pandemic, are there any hypofractionated regimens (without concurrent chemotherapy) that could be utilized for head /neck cancer in a post operative setting?
A very recent paper by Eric Hall and David Brenner’s group (Shuryak et al., Int J Radiation Oncol Biol Phys 2019) is titled “optimized hypofractionation can markedly improve tumor control and decrease late effects for head and neck cancer”. Using a recently improved model, they concluded that an opt...