Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a patient with a prior history of an early-stage breast cancer who now has a 5 cm tumor in this ipsilateral breast with nodal involvement?
One of the important things is the time from the original course of RT. The longer the time from the 1st course the fewer wound complications and toxicities we see. She now has cT3N1 (at least per discussion) triple negative breast cancer. A few options are given plan for mastectomy: If pCR, can co...
How would you approach post-op radiation recommendations in patients who had neoadjuvant chemoimmunotherapy for HPV mediated OPSCC s/p TORS who have a complete pathologic response (pCR)?
Neoadjuvant immunotherapy for patients with TORS-eligible HPV-positive malignancies should not be done off study. KEYNOTE-689 did not include early-stage HPV+ oropharyngeal cancer patients, and as such, there is no prospective data to suggest a benefit to neoadjuvant immunotherapy in this patient po...
Would you offer PMRT to a patient with pTisN1a left breast DCIS?
Macrometastases suggest there is missed invasive disease in the midst of 11-cm DCIS. For one macromet with only SLNB done, I would add CW and RNI as part of treatment, but if I had an ALND, then RT can be avoided.
What features or presentations would prompt you to offer radiotherapy for paraganglioma vs. continued surveillance?
I think aside from symptomatic disease, other criteria I would consider for treating vs surveillance for paraganglioma include size/location where tumor growth in a particular location may lead to progressive/permanent neuropathies and therefore prophylactic RT may be warranted. I am also more likel...
What is your treatment approach for patients with base of skull glomus jugalare tumors (paraganglioma)?
Depending on the patient's performance status, size of tumor, and location within the skull base, I may opt for radiosurgery upfront or simply external beam radiotherapy. For radiosurgery, typically my dose is 16 Gy and for external beam may range from 45 to 50.4 Gy.
Will patients who receive radiation to a large mediastinal nodal field have an increased susceptibility to COVID-19?
While the actual infection of COVID-19 has more to do with hygiene, social distancing, and prevention such as drugs or vaccines, the susceptibility for the patient to develop symptomatic progression of COVID-19, once infected, has a strong theoretical possibility. The factors that impact severe lymp...
For gross hematuria from a primary bladder tumor, what palliative radiation regimen would you recommend?
I found that 36 Gy/6 Fx delivered weekly is a great option for palliation.This has been used in curative system, as well, but I find it to be particularly helpful in elderly patients or those with travel issues. There is a phase 2 study in patients who are medically inoperable and the local control ...
How do your PMRT recommendations change with ITCs after neoadjuvant chemotherapy if they had SLNB only versus ALND in light of B51?
Data such as from Dana-Farber/Brigham and Women’s Cancer Center and the National Cancer Database (Wong et al., PMID 31228134), as well as the OPBC-05/ICARO study (Montagna et al., PMID 39509672), indicate that patients with isolated tumor cells in axillary nodes after neoadjuvant chemotherapy (ypN0i...
What are the indications for PMRT in an ER/PR(+) Her-2(-) patient with a complete pathologic response in the nodes after neoadjuvant chemo, but with residual disease in the breast?
This is an area where there is still a paucity of information. Hence, all guidelines need to be very tentative. I recommend PMRT for all patients having biopsy-proven axillary node involvement prior to chemotherapy, as I am concerned these are the patients at highest risk of local-regional failure. ...
Do you omit PMRT for patients who would have been eligible for NSABP B-51, but are found to have significant pure LVSI only, without stromal carcinoma, after neoadjuvant chemotherapy?
I would treat it like a partial response and favor RT.