Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend a simultaneous integrated boost with hypofractionated whole breast radiation?
With the presentation of IMPORT HIGH trial (CRUK/06/003) at SABCS last month, the data for simultaneous integrated boost SIB in breast cancer is accumulating. This was a phase III trial that randomized 2,617 women to a sequential boost (50Gy +16Gy), SIB arm (40Gy to breast with 48 Gy to boost volume...
Do you try to incorporate mFOLFIRINOX in total neoadjuvant therapy for rectal cancer?
PRODIGE 23 study is an open-label, randomized phase 3 study (Conroy et al., PMID 33862000). Locally advanced rectal cancer patients (cT3 or cT4 M0) were randomized to either the study arm (mFOLFIRINOX X 3 months, chemoradiation, TME, FOLFOX X 3 months) or the standard arm (chemoradiation followed by...
How would you approach a patient with invasive breast cancer and DCIS s/p mastectomy and immediate reconstruction with a negative invasive margin, but a close DCIS margins?
I would observe such a patient. With a close DCIS margin post mastectomy, there is very little evidence of a benefit to PMRT. Subsequent local recurrence is well below 10% so I see no clear role for PMRT in such a case. Even if there was a close invasive margin unless there were other aggressive fac...
For multiple myeloma, is 8 Gy in 1 fraction an appropriate palliative dose, although this histology was excluded from trials examining a single fraction?
There was a randomized trial comparing 8 Gy/1 fx vs 30 Gy/10 fx for patients with multiple myeloma. There was no difference in analgesic response or recalcification, however patients with the protracted regimen seemed to have a benefit in terms of QOL. However, the the control arm (30 Gy in 10), th...
Would you recommend stent placement upfront in a patient with cervical esophageal cancer and a TE fistula?
Malignant TE fistula is a complex problem which is often associated with a poor prognosis. Palliation with stenting can be problematic as the stent can erode and make the fistula larger. This is especially problematic with "kissing" stents in both the esophagus and the airway and/or in the setting o...
Do you routinely cover level IA lymph nodes for advanced BOT tumors extending into floor of mouth or oral tongue?
Generally speaking, I would cover any draining nodal region that is at risk based upon the involved mucosal subsite(s). If IA is at risk because of anterior oral cavity disease involvement, I would not omit coverage simply for the fact that the primary originated in another location.
Is there evidence to support partial breast irradiation with daily fractionation?
I agree with @Dr. First Last. Also, there are a number of publications that detail once daily fractionation using external beam delivery. There is a published randomized phase III trial from Florence that used 6 Gy x 5 delivered every other day. I believe this same fractionation regimen has been pub...
How would you manage an early stage HPV mediated pure adenocarcinoma of the tonsil with a large but resectable primary and multiple ipsilateral nodes without clear ECE on imaging?
TORS, neck dissection, and postop RT.
Do you avoid hypofractionated regimen for Grade 3 early stage breast cancer?
The Canadian finding was unexpected and likely not reproducible. Not sure if it will hold up in longer follow-up. START did not find that and I would not withhold hypofractionation based on grade. Whether the boost makes a difference based on grade is pure speculation at this point, but I tend to bo...
Is vocal cord paralysis a complication of thoracic RT?
There have been a few papers demonstrating this with dose to recurrent laryngeal/vagal nerve. Sources below. Kanaoka et al., PMID 37060336 Shultz et al., PMID 25012837 Pierrard et al., PMID 35872055 Carpenter and Rosenzweig, PMID 25436809 Syed et al., Journal of Radiotherapy in Practice 2016