Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your preferred treatment for enlarging bilateral acoustic schwannomas?
This is indeed a very challenging situation, with no easy answers. A number of variables, such as patient age, hearing status, knowledge of sign language, expected longevity, underlying cardio-renal-GI conditions, genetic make-up (NF?), presence of other tumors, etc., would drive the decision making...
Would you consider radiation to the axillary lymph nodes ONLY (omitting chest wall) for patients with 1-3 axillary LNs who would otherwise not receive post-mastectomy radiation (T1-2, clear margins etc) when these patients have or will undergo breast reconstruction?
I am not a fan of this approach. In patients with node positive disease without a locally advanced primary, the majority of local-regional relapses are actually still on the chest wall. Perhaps there is rationale, but if I am to treat regional nodes, I would include the chest wall. I have occasional...
How would you treat an isolated recurrence in the pelvic muscle after prior definitive chemoradiation with brachytherapy boost for vaginal adenocarcinoma?
I would favor SBRT along with systemic treatment for the recurrent disease.
What criteria do you use when choosing an applicator system for cervical brachytherapy patients?
It is all based on institutional experience as dosimetrically there are some differences between the two applicators but would be hard to quantify any clinical outcome difference. There is increasing adoption of ring applicator possibly because of ease and convenience
Are there situations for which you consider concurrent chemoradiation for breast cancer patients?
Most of the experience with concurrent chemoradiation for breast cancer comes from the era of CMF chemotherapy. One of the rationales for delivering RT concurrent with CMF was to avoid delaying radiation for 6 months. In many cases methotrexate was dropped for the cycle overlapping with RT, or RT wa...
Are you offering durvalumab to patients with Stage III NSCLC with known targeted mutations (ie ALK, EGFR, ROS1, BRAF) after completion of chemoradiation per PACIFIC?
The PACIFIC study represents an important advancement for patients with unresectable, stage III NSCLC. The initial OS results were presented recently and demonstrated a significant improvement in survival for patients receiving durvalumab following chemoradiation. The median time has not been reache...
What dose/fractionation would you offer a non-operable patient with a low-lying T2N0 rectal cancer in the setting of prior pelvic radiation >10 years ago?
Assuming non operable excludes local excision, I would treat with contact therapy.
How would you best manage C-spine osteoradionecrosis?
HBO, pentoxyfylline, vitamin E, and prayers. I can’t imagine surgery would be useful except as a last resort. I’m extrapolating from the mandible and maxilla. I don’t recall seeing an ORN of a cervical vertebra. Thankfully.
What is the soonest you can start adjuvant whole breast radiation after surgery?
My general preference is 4-6 weeks (up to 8 weeks) expecting normal healing. I rarely start sooner than 4 due to healing concerns (even if things look good) and have only done this (starting 3-4 weeks post op) a few times due to extenuating circumstances, and only if the healing appears adequate. I ...
How would you treat a head and neck patient who had definitive chemoradiation who develops an isolated mediastinal lymph node recurrence?
45 Gy/25 fx to mediastinum and boost to positive node to 65 to 70 Gy.