Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for radiation in biphenotypic sinonasal sarcoma?
It’s a sarcoma, so there may be a role in the neoadjuvant or adjuvant setting. Not for definitive therapy, however. Surgery is the mainstay of definitive management of sarcoma. If there’s no surgical option then you can consider out-of-the-box approaches with SBRT or hypofractionation, or even brac...
Would use of proton radiation versus photon radiation in neuroblastoma patients post autologous stem cell transplant reduce the risk of transplant associated-TMA?
Transplant-Associated Thrombotic Microangiopathy arises partially due to injury to the endothelium; it is one of the “endothelial injury complications” of hematopoietic stem cell transplantation (HSCT), along with veno-occlusive disease (VOD) and engraftment syndrome (ES), among others. There is a w...
Would a metal endobronchial stent within the treatment field change your radiation treatment plan for a thoracic malignancy?
No, a stent placement within an airway would not alter either the appropriateness or the planning of radiotherapy for a thoracic tumor. That said, I would discuss the long-term implications of a stent in an irradiated field and would follow the patient closely with pulmonary medicine to discuss the ...
In patients with perihilar cholangiocarcinoma eligible for liver transplant, what is the protocol for neoadjuvant chemo-RT, particularly when brachytherapy is not available?
There is a lot of variability in neoadjuvant regimens prior to transplant for hilar cholangiocarcinoma as outlined in the survey paper above. Institutional approaches for total dose, fractionation, and target volumes vary considerably. A couple of points to consider and some personal opinions - Phil...
Would you ever consider SRS as a salvage option as an alternative to whole brain radiation for secondary CNS lymphoma?
The optimal management of secondary CNS lymphoma is not clear. Clinical considerations include the age and performance status of the patient, distribution of disease (CNS only versus systemic and CNS), prior treatment, etc. In most cases, high-dose methotrexate (HD MTX) based regimens are pursued. I...
Do you omit APBI for lobular histology?
If meets the other criteria, we do offer APBI. GEC estro and NSABP randomized trials did include lobular pathology.
Would you consider adjuvant radiation therapy for a grade 1 meningioma with an elevated Ki67?
An answer to this important question requires conjecture as well as additional details. Ki-67 has indeed in some studies been identified as a promising biomarker [Liu et al., PMID 32118704, Tjuatja et al., PMID 36448071, Chen et al., PMID 29624151], however not uniformly so [Jensen et al., PMID 2929...
How would you manage a patient with PSA persistence after RALP demonstrating metastasis in regional lymph nodes without further evidence of disease on bone or CT scans?
First, if possible, I would try to get a PSMA PET/CT. If that is negative, this patient should be started on long-term ADT. In terms of radiation, if they were a candidate for radical prostatectomy, the age/performance status question is probably not a major concern unless their health status has un...
Would you offer salvage radiation for prostate bed recurrence on PSMA PET in a patient with limited bone mets?
I don’t currently offer salvage post-op RT (PORT) to patients with osseous metastatic disease on PSMA-based PET/CT, which is consistent with the per-protocol treatment strategy on EMPIRE-1 (Jani et al., PMID 33971152). I would, however, be open to offering such a treatment on a clinical trial. An ex...
Is there a role for reirradiation for SCC oral tongue with high-risk features (i.e., PNI, close margins) following surgery?
Consider in patients with ENE, positive margins, deeply infiltrative tumors (>1 cm), or T4. Avoid if <6 mo from prior RT, ongoing wound healing issues in target, or pre-existing severe toxicity (e.g., ORN, severe fibrosis), though this is conditional.