Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach elective cranial nerve target volumes for head and neck cancers to account for potential retrograde or anterograde spread along cranial nerves?
In general, I’m electively covering cranial nerve branches in the setting of an advanced skin cancer with at least microPNI, an adenoid cystic carcinoma, an advanced paranasal sinus tumor with micro or clinical PNI or a nasopharyngeal carcinoma with clinical PNI. Occasionally there’s an advanced gin...
How would you recommend treating locally recurrent pancreatic cancer?
Referrals for these patients have been increasing over the last few years, most likely with the advent of more effective systemic therapy (or perhaps with the decrease of adjuvant radiation). I have not found much data to cite for these patients; but I have recommended stability/non-metastatic over ...
Do you omit consolidative RT in pediatric patients with intermediate risk, non-bulky Hodgkin lymphoma who have a rapid early response to chemotherapy?
Yes, if the patients meet the rigid requirements for response, which include a rapid early response (Complete response or very good partial response) after 2 cycles of ABVE-PC chemotherapy AND have a complete response at the end of treatment then the data suggests similar outcomes whether or not the...
Can you re-treat vertebral metastases with SBRT?
I typically utilize the same prescription doses in the upfront and re-irradiation setting. The difference is typically in my cord constraint (and in effect the coverage of the target). In regards to the spinal cord constraint, I typically allow a cumulative BED3 of 70-75 Gy to the cord plus 2 mm acc...
In what clinical situations do you order NavDx?
At MSKCC, we largely use NavDx as part of our post-operative de-escalation trial in which NavDx is checked pre and post surgery to help select patients for de-escalation. If NavDx becomes undetectable after surgery: In patients with pathologic risk factors that warrant adjuvant RT, patients undergo...
How would you manage a POLE mutated, p53 abnormal IA myoinvasive carcinosarcoma of the endometrium with no LVSI?
I would not change the management of IB and above non-endometrioid histology based on mutation analysis as almost all data is for endometrioid histology.
What dose constraint, if any, do you use for the ureters during prostate radiation?
I have never changed the treatment volumes or applied a specific dose constraint. The ureters can sometimes be hard to see on CT, but contrast helps and this is something we don’t routinely do. The vas deferens is another structure we tend to ignore too. I think this will be an increasingly importan...
How would you treat a patient with history of stage I seminoma s/p orchiectomy with enlarging periaortic node and normal tumor markers on surveillance?
With respect to working up the enlarging lymph node, I agree with @Dr. First Last and @Dr. First Last above. If confident that this is seminoma recurrence, tumor markers normal, and if stage IIA or select stage IIB (select non-bulky, <=3cm) cases, our team advocates for radiation to the para-aortic ...
How do you manage disease progression during adjuvant chemoradiotherapy for glioblastoma?
Hospice.
Do you ever consider a dose constraint to the spleen when treating lung tumors with stereotactic radiotherapy?
Spleen-schmeen. :) Which is a non-professional way so say I think it’s okay to treat it. If you consider we used to remove them for Hodgkin Lymphoma, they are important organs but not crucial. If you’re treating a corner of it (which I have done many times) you will be safe IMO. It’s not hollow visc...