Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When using concurrent hyperthermia with reirradiation, is there any benefit to delivering hyperthermia on non-RT days?
Hyperthermia alone, in the absence of radiation or chemotherapy, is not effective as cancer therapy, notwithstanding occasional reports to the contrary from sources of questionable reliability. Hyperthermia is a very effective sensitizer for both RT and chemo. Note that we are not. discussing high-t...
Do you still recommend protons for grade 2 and grade 3 glioma, following the Soprano study results showing a survival detriment?
I should start by saying that I generally do not recommend proton therapy for grade 2-3 gliomas in adults unless there is a clear and specific indication. Modern photon techniques such as VMAT are highly conformal, efficient, and safe, and they form the backbone of the evidence base that guides our ...
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
A network of specialists familiar with cSCC is necessary to optimize care that is tailored and appropriate for each unique case. Avoiding under-treatment and over-treatment is important, but also challenging, given the high volume of cSCC tumors with variable patterns of presentation and numerous cr...
For a patient s/p laryngectomy with positive margins, would you start radiotherapy 6 weeks s/p surgery if there is a delay in concurrent chemotherapy?
The question is a bit challenging without understanding the reason why the patient is suited for XRT but not chemo. My best guesses would be a concurrent infection or PS issues, possibly due to deconditioning after a hard surgery.However, part of the decision would involve when it is anticipated tha...
Under what circumstances would you offer adjuvant RT following breast-conserving surgery for borderline phyllodes tumors?
There is no definitive data, with some suggestion: all with borderline and malignant phylloides after BCT should be considered for RT (Dartmouth single arm study). In our practice, we offer for margin less than a cm, or if tumor is 5 cm and above after breast conserving surgery.
Do you treat synchronous bilateral breast cancers with RT simultaneously or sequentially?
We see a fair number of synchronous bilateral cases here. I am not aware of any compelling arguments or data for sequential treatment over simultaneous. Simultaneous is more efficient in terms of overall length of time, and allows for better coordination of the fields (but there is more time on the ...
What GTV to CTV expansion do you utilize for NPC?
Many have moved in that direction. I believe MSKCC has been doing this for years for HNC. I believe with good imaging/fusion (including MRI), doing direct GTV to PTV (3-5 mm expansion, dependent on imaging protocol) is reasonable and likely less toxic. I do this for most head and neck patients if th...
Should we delay adjuvant breast radiotherapy for early stage breast cancers as the COVID-19 situation evolves?
This is a very tough question given the unprecedented nature of this pandemic and the fact that its duration is unknown. Recommendations will likely vary based on the density of cases in a specific geographic location and will undoubtedly change frequently given the rapidly evolving nature of this s...
How would you treat a sebaceous carcinoma of the orbit definitively with radiation, if they refuse exenteration?
I would stress that RT would destroy the eye. 70 Gy at 2 Gy per once daily fraction and electively irradiate the regional nodes. Would prefer SIB. No chemo.
How will the LORETTA and COMET trials influence your treatment of low-risk DCIS?
Clearly, postop RT can be avoided, but the pink elephant in the room is, can 5 years of endocrine therapy likewise be avoided? Treatment de-intensification requires addressing all aspects of therapy, particularly if one argues against adjuvant therapies for reasons of cost and toxicity. I can't reca...