Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you include the clinically negative contralateral neck in your field for a lateralized oral cavity who has N2b disease after LND?
There is early N2b and advanced N2b. Generally, no. Lots of disease and ENE, now N3, where obstructed lymphatics could result in crossover, then yes. Medial extension of the primary into the tongue base (unlikely) would also lead to contralateral neck RT. Dose would be 50 Gy in 25 fractions or equiv...
In fully resected oral scc pts with high risk factors that does not cross midline, would you radiate the contralateral neck if it is pN0?
I had responded to a similar question some time ago. I am copying my response below. I do not feel comfortable omitting RT to the neck in cases of oral tongue cancer. The lymphatic drainage of the oral tongue is complex. The textbook on Head and Neck cancer by Million and Cassisi (2nd ed., Figure 16...
What factors do you typically consider when deciding whether to include retropharyngeal lymph nodes within your treatment volumes for squamous cell carcinoma of the oral cavity or oropharynx?
I see no reason to treat the retropharyngeal nodal region prophylactically for oral cavity cancer as that is not pattern of spread for oral cavity. For oropharyngeal cancer we include the lateral retropharyngeal nodal region for all patients and include the medial retropharyngeals only if the latera...
In patients treated with the KEYNOTE A-18 regimen who later recur, would you rechallenge with immunotherapy again?
Limited data in this clinical scenario. Per A18 (Lorusso et al., PMID 38521086), 32 patients received ICI as post-progression therapy, 25 of whom received Pembro. I am unable to find in the supplements whether those were patients from the placebo arm or from the pembro arm.I think if the patient rec...
How would you treat epithelial-myoepithelial carcinoma of the parotid following resection with clear but close surgical margins?
I would try to get the pathologist to nail down a grade. Low or intermediate, I would follow if close but negative. High, I would treat. I think that they are usually low grade. Really close on the 7th nerve, (<1-2 mm), I’d treat.
Would you offer adjuvant radiation to a low grade myoepithelial carcinoma of the soft palate with positive margins and no other aggressive features?
This situation is relatively more common when the surgical procedure was an excision biopsy for diagnosis rather than a planned oncological resection. The usual first Q in this scenario is whether the surgeon could go back and perform a wider excision without compromising function. This is a tricky ...
If a patient with locally advanced cervical cancer cannot receive brachytherapy following 45Gy to the whole pelvis, how do you optimally deliver your boost?
One should be very cautious, as in our experience the situation where you can't do brachytherapy is very rare. There is a trend in the country to use a non-brachytherapy boost as it is more accessible but this approach can lead to worse outcomes. See Dr Viswanathan's paper recently published in the ...
Do you recommend definitive chemoradiation for unresectable gastric adenocarcinoma in a medically unfit patient?
Definitive is probably not the best term for what can be done. Only palliative doses are possible because the stomach is so sensitive, the GTV is difficult to clearly define, impossible to see on CBCT, the stomach changes shape from day to day, and moves with respiration. There would only be a less ...
Which chemotherapy should be held while delivering palliative radiation?
Any chemo that is considered a radiosensitizer should be considered as potentially increasing toxicity during palliative RT, and the question of whether to hold these agents should be carefully considered at the very least. This includes but is not limited to: doxorubicin, gemcitabine, taxanes, 5FU,...
What data support the use of continuing GnRH therapy "backbone" in metastatic castration resistant prostate cancer (mCRPC) receiving additional therapies?
The short answer is that ALL phase 3 trials of life-prolonging therapies now approved in mCRPC required ongoing ADT (medical or surgical) and there is not a single positive life-prolonging phase 3 trial that did not do this. Until then our strongest evidence is to follow how these trials were conduc...