Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there instances where you prefer an SBRT boost rather than a brachytherapy boost when treating definitive locally advanced cervical cancer?
No.
In what scenario would you give consolidation chemotherapy after chemoradiation for stage 3 cervical cancer with a good response?
The current standard for stage IIIB cervical cancer is primary external beam radiation + concurrent cisplatin based chemotherapy + brachytherapy (see NCCN guidelines CERV6). Clearly, given the failure rate with distant metastases after primary therapy, there exists significant interest in adjuvant c...
For a patient with recurrent endometrial cancer involving the vagina with a good response to EBRT (<5mm residual), how would you prescribe adjuvant brachytherapy with a cylinder to the entire vaginal length?
We focus on pre EBRT length, as recurrence patterns don’t support needing to treat the full length with 45Gy from EBrT sufficient, and series that have treated full length have shown higher toxicity.See discussion of this for summary of literature for volume of treatment.
Would you offer definitive RT to a patient with metastatic cervical adenocarcinoma s/p carbo/taxol/avastin with a partial response in the metastatic sites?
I have delivered definitive pelvic chemoradiotherapy to a handful of patients who had complete radiographic responses to neoadjuvant TCA. All patients remain disease-free several years later. As for a patient with only a partial response, I believe there is still a good argument to be made for the a...
How would your follow-up change for a patient, non-surgical candidate, with endometrial cancer treated with definitive radiation?
I assume that the question refers to how follow-up would differ between a patient treated adjuvantly, i.e., following surgery, versus treated definitively, i.e., not a surgical candidate. I think there are quite a few variables here. Probably the most important consideration is the extent to which t...
Would you offer any adjuvant therapy for cervical cancer following total pelvic exenteration in the setting of a positive pelvic lymph node?
I am going to "eat a bit of crow" here and admit to having been schooled a bit by the esteemed Dr. @Dr. First Last. I admit to having immediately jumped to the post-rad hyst situation rather than post-exenteration, and I agree that the radicality of the operation could factor into the decision about...
Would you modify standard WPRT+brachy radiation for cervical SCC s/p negative nodal staging but aborted hysterectomy due to previously undetected superficial vaginal disease?
Would treat same with EBRT to 45 Gy in 25 fractions. (Pelvis) With concurrent chemo and brachy.
Can trastuzumab deruxtecan be continued during radiation?
Data is limited, with the suggestion of higher necrosis with SRS. For other sites for palliation, I would not say it’s contraindicated, but caution needs to be exercised especially for the risk of increased lung and GI toxicity (because of independent toxicity from the drug and the potential for sen...
Given the negative results of GOG-0238 but the positive results of the RUBY trial, how do you manage isolated vaginal cuff recurrence of endometrial cancer?
I would favor definitive RT alone and reserve chemo plus IO for systemic or nodal relapse.
Do the number of lymph nodes removed in a non-Stage IA/FIGO 1 endometrial cancer case, affect your decision for WPRT v. vaginal brachytherapy alone?
Yes, in some cases it does—for two reasons. If a patient has had an extensive negative node dissection, the risk of extravaginal pelvic failure is undoubtedly less and the risk of RT complications may also be greater than if the patient had hysterectomy only. These factors define the “therapeutic ga...