Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For non-metastatic MIBC patients with incomplete debulking TURBT, who are not surgical candidates for cystectomy or repeat TURBT, would you try chemoRT or proceed directly to systemic treatment?
Definitely chemoRT. I believe around 1/3 of patients on BC2001 had biopsy only or incomplete TURBT. No doubt maximal TURBT is preferred, but when it is not possible, that is not a contraindication to definitive treatment. If not a chemo candidate (though there are several options), I would recommend...
How would you best manage a medically inoperable oral cavity squamous cell carcinoma that is locally advanced and node-positive with likely extranodal extension?
Assuming the patient can receive chemotherapy, the expected DFS from standard concurrent chemo-RT is 50% or less. Options to try and improve the prognosis are 1. Higher RT dose than standard, 2. Altered fractionation alone, 3. Altered fractionation concurrent with chemo, 4. Adding cetuximab to concu...
Would you recommend BCS and adjuvant radiation for early stage multicentric breast cancer?
In the era when advanced breast imaging was not available, the data suggests that the risk of IBTR was high with BCS and RT. This could have been because of under assessment of the extent of disease in breast. The limited data in the modern era suggest the risk of IBTR may not be that high (using MR...
What criteria do you use when considering treating the pelvic nodes in a salvage prostatectomy case versus covering only the postoperative bed?
Since we don't have any high-level evidence with which to guide us, this is a question with which I am constantly struggling, too, and frankly, my practice has changed over the years. In general, I will consider irradiating the pelvic nodes in patients with Gleason 8-10 tumors, seminal vesicle invas...
How do you approach treatment of a spinal meningioma?
Surgery is usually the first option. If there is a good resection, the histology is WHO grade 1 (usually) and any residual tumor, if present, does not threaten the spinal cord, one could observe and decide on further action later when the tumor shows signs of growth. If the surgery is only a biopsy ...
Did NRG LU004 demonstrate safety with hypofractionated lung radiation and concurrent ICI?
We reported the initial safety results at ASCO in 2022 after the trial was completed in 2021. There are no DLT signal and safety concerns of combining durvalumab with radiotherapy, whether it is conventionally fractionated or hypofractionated. The manuscript is under preparation incorporating some b...
What is your treatment approach for a pediatric patient with uterine embryonal rhabdomyosarcoma found after removal of a prolapsing uterine mass, with no evidence of distant metastasis on imaging?
Based on the location of the uterus, this would be a favorable site. In the scenario presented, the tumor is noted to be removed, but the margin status is not noted, which could greatly affect the approach. Also, the exact uterine location (such as cervix vs body of the uterus) may make a difference...
What would be a reasonable radiation approach and dose for a patient with multiple myeloma with brain involvement?
I would first wish to clarify what is meant by "brain involvement."When plasma cell neoplasms of the brain occur, they are usually the result of significant marrow involvement of calvarium and/or skull base with focal intracranial extension, or plasma cell infiltration of the leptomeninges and dura....
How do you manage leptomeningeal carcinomatosis from a metastatic solid tumor?
Several factors are usually considered prior to deciding how to manage patients with leptomeningeal carcinomatosis from a metastatic solid tumor. These factors are tumor type, performance status, neurological status, the bulk of CSF disease, the extra-cranial tumor burden as well as the chance of th...
How aggressive would you be in irradiating asymptomatic bone metastases in a patient with metastatic prostate cancer?
I used to tell patients who were referred to me for asymptomatic bone mets to defer treatment until they began having pain (unless there was an impressive radiographic lesion or concerns of impending pathologic fracture or cord compression). But the multicenter, randomized trial presented at the Ame...