Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
When do you consider elective pelvic nodal irradiation for unfavorable intermediate risk prostate cancer?
I consider elective pelvic nodal irradiation for patients classified as unfavorable intermediate risk by virtue of having Grade Group (GG) 3 disease, especially if they have high volume disease (50% or more of the cores are positive). These patients have a risk of lymph nodal involvement that is in ...
Would you offer PMRT to ER/PR+ patients with synchronous bone metastasis?
This is a more common scenario despite data suggesting a local survival benefit with the addition of local therapy to patients with metastatic breast cancer. With synchronous bone mets- we usually start with systemic therapy, ER+ would be endocrine therapy + CDK 4/6 inhibitor commonly. If stable/res...