Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat a uterine carcinosarcoma with omental spread with adjuvant whole abdominal radiation?
I would not offer any external beam irradiation for this patient. Even isolated omental spread in uterine carcinosarcoma represents metastatic disease. Thus, they only reasonable option is chemotherapy, usually systemic agents such as carboplatin and paclitaxel or cisplatin and ifosfamide.
For an otherwise resectable esophageal cancer with involved celiac lymph nodes, would you ever consider an SIB beyond 50.4 Gy?
Intuitively, it seems like 50.4 Gy is not enough, as pathologic complete response rates are low. Based on multiple randomized trials, no dose higher than 50.4 Gy has been superior to 50.4 Gy for esophageal cancer. This included the primary tumor and grossly involved nodes. The NCCN now recommends st...
Would you recommend radiation for an unresectable chest wall recurrence after two prior courses of radiation?
The answer depends on multiple factors: 1) How extensive is the present disease 2)Is there evidence of distant mets 3) What was the prior dose of RT and when 3) What types of systemic therapy have been used, what was the response and when 4) What is the patient's overall condition 5) Does the skin s...
For NSCLC patients who are polymetastatic who then become and remain oligometastatic, is there a role for local ablative RT to the primary and metastatic sites?
I think it's an evolving area. I've had several patients with metastatic NSCLC where all their disease except for a couple of spots resolved on subsequent pet scans, for example. The med oncs ask if we could treat those, and I generally will on the theory that these sites might have a different biol...
What are your top takeaways from ASTRO 2023?
1. LBA 05: Wong JS, et al. Patient-reported and toxicity results from the FABREC study: a multicenter randomized trial of hypofractionated vs. conventionally fractionated postmastectomy radiation therapy after implant-based reconstruction. This is the first report of one of the two trials in North A...
For a young patient with advanced TNBC with a single lung nodule status post NAC, not amenable to biopsy, would you consider SBRT to the lesion?
Look for prior imaging (they’re young so may not have prior chest imaging with any significant lead time to draw any conclusions). In the absence of any evidence of other sites of disease and no history of evolution of that nodule, I’d move forward with the completion of appropriate adjuvant therapy...
How would you manage a borderline resectable pancreatic cancer s/p induction chemo + chemo-RT who was unable to go to surgery?
Tough situation. If there was stable/slight progression of disease at 6 months, I would not be inclined to offer reirradiation at that time. If any possibility of radiographic stability, tumor markers were stable, and the patient was clinically well, I would continue with close surveillance. If clea...
What is the management of locally recurrent brain metastases that has undergone multiple resections and previous cavity SRS?
For local recurrence after prior SRS that we're convinced does not represent treatment effect, I consult with my neurosurgery colleagues regarding further surgical options including laser interstitial thermal therapy (which is typically preceded by biopsy). If surgical options don't exist, I general...
Would you offer lung SBRT to a medically inoperable patient with systemic lupus erythematosus or other connective tissue disorders if well controlled?
This is a very timely and clinically relevant question that had intrigued us for quite a while. Thus, we looked into our over 10 year experience at UCLA for 197 adult patients with collagen vascular disease. This work was recently published in JAMA Open Network: Yoon et al., PMID 33599771.The hypoth...
Is there a role for pre-operative RT (+/-chemo) for a borderline resectable Klatskin tumor as an attempt to try to get them to surgery?
From my perspective, there is a role for preoperative chemo-radiation for borderline resectable Klatskin tumors followed by re-evaluation for surgical resection (standard resection vs liver transplant). Neo-adjuvant chemo-radiation followed by liver transplant has been evaluated as a treatment opti...