Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you ever treat regional lymph nodes for malignant phyllodes tumor of the breast?
I have not treated regional nodes in malignant phyllodes cases, even in larger tumors.
How does the recently published SOUND Trial affect your approach to breast RT?
This is a great question. Some radiation details were given in the SOUND trial. We know that ~98% of women in both arms got radiation. The vast majority of patients got whole breast radiation (84% in the SLNB group and 81% in the no axillary surgery group) and a smaller group got PBI with IOERT (~11...
Do you have a size cutoff for liver SBRT?
I favor SBRT for lesions <5 cm, highly select cases between 5-7 cm with favorable anatomy in a relatively large liver (not common in my practice), and are distanced from the central biliary tree/porta (i.e. >1-2 cm). For cases that do not meet these criteria or for which reasonable liver constraints...
How would you manage a solitary unresectable liver metastasis?
Excellent question! Before starting any systemic treatments, has the patient undergone an MRI? Conducting an MRI prior to systemic therapy is crucial for accurately determining whether there are single or multiple liver metastases. The CAMINO study has shown that incorporating an MRI at the initial ...
Would you offer post operative radiation for a patient who had findings of lymphovascular invasion on salvage resection of a recurrent obturator node after definitive chemoradiation for cervical cancer?
If no gross disease and has had previous RT, I would favor no additional RT.
How do you consider SBRT relative to other emerging therapies for pediatric sarcomas, such as proton therapy or immunotherapy, in terms of efficacy and safety?
Treatment paradigms for pediatric malignancies have evolved through group trials over the past 5 decades, both in the US (e.g., COG) and abroad (SIOP). Sequential improvements have been made over the years to the quality of radiation for both pediatric and young adults, a population at risk for majo...
What factors would prompt you to offer post-operative RT in early-stage (T1-2N0) nasal cavity squamous cell carcinoma?
Margins less than 5 mm or piecemeal excision. PNI
How do you manage glioblastoma presenting with leptomeningeal dissemination?
Hospice is a very legitimate option. As physicians, we recommend this far too infrequently.
Would you treat a prostate cancer patient with a positive peri-aortic node?
Such patients are good candidates for treatment. Patients with non-regional LNs (M1a) were included on STAMPEDE. In the M1a subgroup analysis presented at ESMO 2019, there was a significant improvement in FFS (HR 0.64, 0.43-0.96) and a trend to improvement in OS (HR 0.62, 0.35-1.09) (~180 patients i...
Is APBI appropriate in post menopausal women with small, triple negative breast cancers excised with negative margins?
We do have data to suggest that these patients do poorly with mastectomy alone vs other t1/t2 patients: Wang et al., PMID 21852010 Abdulkarim et al., PMID 21670451 Extrapolating from that, biologically, these seem to be more aggressive both locoregionally (despite mastectomy/removal of all breast ti...