Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What measures should we take regarding routine follow-up visits for well patients in surveillance during the coronavirus pandemic?
3-6 months.
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
Anorexia/cachexia is often distressing to patients and families and it is this distress that is the target of many of the interventions for this syndrome as there are, in general, no effective therapies. Patients and families are routinely battling over the lack of eating as this causes further disc...
How do you manage a patient with a 3.5 cm squamous cell carcinoma of the perianus (with no involvement of the anal canal) with a positive inguinal node?
Like an anal canal
What is your approach to a completely resected WHO grade II meningioma?
Any attempt toward a definitive answer to this question will at best be too cursory and at worst will jar Pandora’s box, but let’s give it a shot. How to optimally approach patients following gross total resection (GTR) of a WHO grade 2 meningioma remains sufficiently uncertain that 2 randomized tri...
Can SRS be used to treat an atypical meningioma?
I agree with @Dr. First Last, and approach patients with atypical meningioma in the same fashion, preferring IMRT to SRS. Indeed most publications have used fractionated external beam therapy, but several centers have published results with SRS. I encourage anyone to have a close look at these. The ...
How are you clinically incorporating the data presented from RT Charm at ASTRO 2024?
This is an appropriate question with the presentation of RT CHARM at ASTRO a few weeks ago. We have been utilizing hypofractionated NON-reconstruction PMRT and regional nodal breast RT for years in my practice given our large geographic catchment area. As a general rule, I feel it's always best prac...
How do you manage a stage I LLL medically inoperable lung cancer in close proximity to the stomach?
This is a rare but not uncommon problem (or maybe unusual but not infrequent...). There’s a couple ways to approach this, depending on the tools in your department‘s toolkit. These low lying LLL lesions are ones that I always treat with breath hold (or gated if you have that). You could also look at...
How would you approach local therapy (surgery or RT) in a patient with radiographic complete response after chemoimmunotherapy for non-small-cell lung cancer?
Only 1/96 patients (0.6%) of patients on CheckMate 816 had a complete response by RECIST so I don't think our current paradigms are really driving these kinds of responses. Additionally, there is clearly a disconnect between clinical response rates by RECIST (0.6%) and pathologic complete response (...
How would you counsel a patient concerned about receiving IMRT rather than IMPT for oropharyngeal cancer?
I would tell the patient there is absolutely no concern at all with IMRT, and it is a very well-established SOC. I am personally unclear about the OS benefit with IMPT, as it was pointed out, unexpected. It is unusual to see no difference in PFS and no tox difference, and yet there is an OS differen...
Given the favorable data for the FAST and FAST-Forward trials, can we consider those ultra-hypofractionated whole breast radiation schemes to be standard of care for early-stage breast cancer?
With respect to FAST (28.5 Gy in 5 fx over 5 weeks), it can be considered based on 10-year data. Local control rates were low in all arms, but in general, I limit this to patients who can't do standard hypofractionated WBI (40/15).FAST-Forward now has 10-year outcomes and can be considered for appro...