Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with high-risk cutaneous squamous cell carcinoma of the face with extracapsular extension after ipsilateral neck dissection and rapid contralateral cervical nodal recurrence, what is the optimal management?
In various published series, around half of patients fail to achieve a complete response to cemiplimab. From the clinical details, the current active area of disease appears to be the contralateral neck with no distant disease. Curative treatment is preferred. C-POST trial established surgery + adju...
For locally advanced NSCLC, does endobronchial tumor debulking just prior to treatment influence your decision making regarding bronchial tissue constraints/expected toxicity?
Bulky, large endobronchial lesions both bleed and obstruct. The concern should be the length and depth of the tumor. If destruction of the trachea or bronchial tumor risks bleeding and B/P fistula, it may account for some of the hazards associated with “ultra-central” location. The endobronchial deb...
How would you empirically manage a large sellar/suprasellar mass with encasement of the right cavernous and terminal internal carotid arteries?
Knowing the histology of the mass would really help in creating more accurate treatment recommendations. A biopsy of a sellar mass is usually accomplished by an endonasal-endoscopic transsphenoidal approach utilizing the expertise of an ENT surgeon and a skull-base neurosurgeon. However, in this cas...
How do you counsel patients on the risks and benefits of chemotherapy or radiation offered with palliative intent?
Before I start counseling a patient on these decisions, I want to know a few things first. I would want to know from the oncologists what they think the benefits are (i.e., how much more time might they get? Symptom control?) and what the risks are. The chances that the patient will see a benefit. ...
What is your treatment approach for a pediatric patient with H3K27M-mutant diffuse midline glioma following progression after radiation therapy?
First, if the patient is at least six months from initial radiation and has had a reasonable initial response, reirradiation is the best proven treatment for recurrence. We would also encourage enrollment on a clinical trial (the DMG National Tumor Board is a helpful resource for determining for whi...
Does non-urothelial histology impact your approach to chemoradiotherapy for muscle-invasive bladder cancer?
There is no randomized data available in this regard to guide us through non-urothelial histologies for MIBC. However, certain points that are worth considering in their management are: For small cell or neuroendocrine tumors, cisplatin/etoposide or ifosfamide/doxorubicin-based systemic therapy in ...
In the setting of prior salvage radiation therapy for rising PSA post prostatectomy, can there be any role of additional radiation therapy for isolated local recurrence in the bladder neck/prostate bed?
I have not run into this scenario. If it is visible on imaging (ultrasound +/- CT or MRI) I would explore the possibility of HDR, 13.5 Gy x 2. Careful consideration would need to be given to the location of the recurrence and anatomy. Technically it may be challenging due to scar tissue and the limi...
In a patient with rectal cancer, when would you consider brachytherapy monotherapy or brachytherapy boost after CRT?
For a patient with cT2N0 disease, the most appropriate use of brachytherapy would be sequential with pelvic radiotherapy, the bulk of data being with long-course CRT. Brachy can either be done prior to CRT or sequenced afterwards. We routinely use brachytherapy in appropriate candidates in our pract...
Would you offer hypofractionated radiation regimens for a young patient with glioblastoma with good performance status but travel concerns, making 6 weeks of radiation difficult?
I am not a neuro-radiation oncologist, but I must register my disagreement with Dr. @Dr. First Last answer. This is GBM. The cure rate is exceedingly low, no matter what the fractionation, age of the patient, PS, etc. We should work with the patient to maximize their remaining quality of life and no...
What are fractionation options for a patient with progressive jugular foramen paraganglioma now causing multiple cranial nerve deficits?
I typically individualize fractionation based on tumor volume, proximity to brainstem and cochlea/IAC (especially when serviceable hearing is present), and the pattern of cranial nerve deficits. For tumors <35 cc, I favor SBRT 24 Gy in 3 fractions, with escalation to 27 Gy when aiming for maximal tu...