Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer local consolidative therapy for patients with polymetastatic driver mutation-positive NSCLC who respond well to targeted therapy?
This is a great question. In phase II prospective study, Gomez and colleagues (Gomez et al., PMID 31067138) demonstrated a PFS and OS benefit with local consolidative therapy in patients whose disease did not progress after first-line systemic therapy. In my opinion, local consolidation therapy to o...
Would you recommend adjuvant radiation after wedge resection for a 1.0 cm non small cell lung cancer with close margins of 2mm?
We do not recommend adjuvant radiation for close (or even positive) margins after a wedge resection. The rationale for a wedge resection (as opposed to lobectomy) typically stems from some level of medical risk in a patient precluding more standard upfront resection. Difficulty localizing the site o...
What is your approach to solitary node positive bladder cancer (e.g. N1) in a patient who is otherwise a candidate for either bladder preservation or radical cystectomy?
This is a very intriguing question, with limited prospective data to guide us. I will frame my response on a patient with clinical node positive (based on imaging) bladder cancer and a candidate for bladder preservation or cystectomy. This patient is deemed metastatic yet there may be a subset of t...
What is the best management of an unruptured Spetzler Martin grade 3 arteriovenous malformation in a young patient?
This is a complex question and first and foremost requires and understanding of the natural history of an AVM.Natural history of cerebral arteriovenous malformations: a meta-analysis Nine natural history studies with 3923 patients and 18,423 patient-years of follow-up were identified for analysis. T...
Do you modify the whole brain radiation dose if a patient has previously been treated with SRS for brain metastases?
Do you offer radiation in the setting of a resected desmoplastic melanoma with negative margins given that several retrospective studies show a local control benefit?
Desmoplastic melanoma represents a minority of cutaneous melanoma lesions and typically occurs in the head and neck region, more commonly in elderly men, and typically diagnosed with an advanced Breslow depth. Historically, the outcomes associated with desmoplastic melanoma following resection were ...
What SABR dose-fractionation would you use when treating an oligometastatic site in the femur or weight-bearing acetabulum?
This is a very good question. We only excluded femoral sites from COMET out of an abundance of caution, not because of any evidence suggesting fractures in this location.We were worried that a couple of fractures would not only cause harm, but would also end the trial, particularly as they can lead ...
How do you approach radiation therapy for a target volume adjacent to a WATCHMAN atrial appendage closure device?
The WATCHMAN is a non-electronic device so it does not carry the same concerns for device disruption for which we have dose limits (i.e. pacemaker, ICD, etc.). There could be a consideration of the impact of radiation dose on healing/tissue formation over the device in the period immediately after p...
What dose would you give for unresectable anaplastic thyroid carcinoma?
Palliation sometimes can be more complex than definitive treatment in head and neck, particularly when the patient does not have distant disease. Having trained at MDA, I have frequently used the Quad shot (14Gy/4fx, given with BID fx c 6h in between fx) (Corry et al Radiother Oncol, 2005) It is rel...
How do you approach the use of parathyroid hormone-related protein analog drugs in the setting of prior external beam radiation?
The concerns about prior external beam radiation are due to the independent increased risk of osteosarcoma associated with external beam radiation. The boxed warning associated with the PTH anabolic drugs WARNS that patients with prior radiation should not receive PTH anabolic drugs. (Note this is n...