Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there an optimal bridging radiation dose for aggressive B-cell NHL undergoing CAR T-cell therapy?
The perfect radiation dose for a given patient probably depends on a number of patient and disease-specific factors including tumor biology and genetics, the anatomy of the tumor and adjacent organs at risk, and the radiation technique used. We do not have the ability to recommend such individualize...
How do you decide what elective lymph node stations to include in your treatment volume for cervical and upper and middle thoracic esophagus cancer?
I hate to describe it this way. However, unless there is imaging evidence of specific nodal disease, the nodal coverage for esophageal cancer is mostly one of convenience (both for the patient and the physician). For distal lesions I like to cover the celiac axis and for proximal lesions I like to c...
How do you manage multiple cavernous malformations that have bled and enlarged over time?
Intracranial hemorrhage (ICH) is one of the most common manifestations of cerebral cavernous malformations (CCMs) occurring in about 25% of the cases. Two recent meta-analyses report a risk of 15% of ICH at 5 years. The treatment of these patients is very controversial. A recent population-based stu...
Is there a role for XRT in the treatment of epistaxis from hereditary hemorrhagic telangiectasia?
Here is a case report about its utility: Niyazi et al., PMID 20368796. I recently saw and plan to treat an elderly patient with a locally advanced cutaneous squamous cell carcinoma invading the nasal cartilage. I plan to give 60 Gy to the skin cancer and a lower dose to the nasal mucosa (perhaps 50 ...
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...