Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In oligometastatic NSCLC with a solitary brain metastasis and lung primary amenable to SBRT, how would you sequence first-line systemic therapy versus local therapy to the lung after treatment of the CNS metastasis?
Would generally favor appropriate first-line systemic therapy whether that be immunotherapy +/- chemo vs. targeted therapy and if at least stable disease at the next surveillance imaging (~3 months), go ahead and consolidate with SBRT. I don't think it would be wrong to do SBRT upfront here but the ...
When treating early stage breast cancer with adjuvant RT, what risk factors would lead you to include the level 1 and 2 axilla in patients with pN0(i+) disease?
I would not offer for pN0(i+) patients. It barely makes a dent in the patients that have an indication.
When do you offer PMRT for clinical T3N0 breast cancer with a pCR after neoadjuvant chemotherapy?
I think this is a very interesting question, and one about which we have relatively little data. For pathologic T3N0 disease treated with mastectomy, radiotherapy is reasonable (NCCN tells us to "consider RT") but, I believe, falling out of favor. Data from the NSABP suggest that the 10-year risk of...
What is the recommended treatment approach for stage III/IVA nasopharyngeal cancer that is p16 negative and EBV positive?
The recommended treatment approach for stage III/IVA EBV-positive nasopharyngeal cancer is induction chemotherapy with gemcitabine/cisplatin followed by concurrent chemoradiotherapy with cisplatin.This was established in a phase 3 trial that compared induction chemotherapy plus concurrent chemoradio...
How should the V10 or V12 be defined when evaluating intracranial SRS plans?
Milano et al., as part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy investigating normal tissue complication probability (HyTEC), published a review of 51 studies in 2020 and evaluated the risk of symptomatic radiation necrosis based on a defi...
Is there an "ideal" method for abdominal motion control when treating upper abdomen malignancies?
When using doses that potentially exceed OAR tolerance (specifically luminal GI,common and main bile ducts, liver) in the upper abdomen it is important to not only have a solution for organ motion, but some form of high quality image guidance. When giving a BED of <60 Gy, there is no need to use the...
What are your indications for including the contralateral neck when planning postoperative primary and ipsilateral elective neck radiotherapy for a well lateralized buccal squamous cell carcinoma?
No indication for contralateral neck RT in cases of buccal primary ca. If there are high risk features in the ipsilateral neck or primary tumor, LRR risk will mostly be confined to those sites.
What rates of radiation-induced secondary malignancies do you typically quote to patients in their 30s-40s?
This is an excellent question. Current breast cancer treatments yield great local control and overall survival rates; thus, leaving long term toxicity for breast cancer treatment as a major concern. As a resident, I often quoted patients the risk of secondary malignancies from radiation therapy to b...
Is PMRT routinely recommended for all patients with positive lymph nodes after neoadjuvant chemotherapy?
This is a good question. In general at MD Anderson, we tend to recommend post-mastectomy radiation therapy for patients with residual micro- or macro-metastatic disease in the axillary nodes after neoadjuvant chemotherapy. This recommendation is strong when the patient had clinical stage III disease...
How do you treat newly diagnosed low volume metastatic hormone sensitive prostate cancer in light of new data from STAMPEDE presented at ESMO 2018?
In the prespecified subset of men with mHSPC and low volume of metastases (CHAARTED criteria of 4 or fewer bone metastases and no visceral metastases), there was a 32% improvement in overall survival (HR 0.68 95% CI 0.52-0.9) which was statistically significant and is clinically significant. Given t...