Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you give adjuvant RT to vulva in a patients with node positive vulvar cancer and no high risk features for vulvar recurrence?
There is variation in practice. I tend to treat primary also along with nodal volume as long term data shows a 25- 35% risk of LR and a low 65% salvage rate. Data unknown is how much would RT reduce this and if these are true recurrences or new primary. Te Grootenhuis et al., PMID 26428940
How would you approach a vulvar cancer with para-aortic and pelvic nodes?
I have treated a few patients with curative intent if ECOG 0-1. Especially if HPV positive. Below is the link to outcome for anal cancer with pa node involvement.Holliday et al., PMID 29907489
For adjuvant radiation decision making purposes, how is the "Lower Uterine Segment" (LUS) defined?
We have always used the pathologist's description of LUS (fundus, body, LUS, and cervix). That being said, I don’t use LUS as risk factor for deciding adjuvant treatment except in borderline cases where may lean towards brachytherapy if otherwise a candidate for observation.
What are your top takeaways in Breast Cancer from ASCO 2022?
DESTINY-Breast04: it is phase III study of Trastuzumab deruxtecan (T-DXd) vs treatment of physician’s choice in HER2-low metastatic breast cancer (MBC). This study showed improved progression-free survival (PFS) and overall survival (OS) with T-DXd vs standard therapy in this patient population. T-...
What are your top takeaways in GI Cancers from ASCO 2022?
1. DYNAMIC study: I believe circulating tumor DNA (ctDNA) will dramatically improve personalized medicine for cancer patients. This study confirmed that ctDNA-based adjuvant chemo treatment significantly decreases the patients who need/are recommended for adjuvant treatment (50% reduction) without c...
What are your top takeaways in GU Cancers from ASCO 2022?
1. Bladder cancer. Potential new non-muscle invasive bladder cancer immunotherapy with N-803, an IL-15 superagonist plus BCG. Abstract 4508. Demonstrated striking complete and durable remissions (70%), bladder preservations over 1-2 years of follow up (>90% cystectomy free survival), favorable toxic...
Do you have particular recommendations for management of a nipple piercing during adjuvant breast radiation?
I have never had a case where this was an issue (i.e., piercing done during the RT). Nevertheless, I would consider this similar to any small wound (e.g. biopsy) within a site being actively irradiated. I certainly have done punch biopsies during chest wall RT and not do not recall having problems. ...
In patients with CML on imatinib and newly diagnosed breast cancer now requiring radiation therapy, should we hold imatinib?
I recommend continuing imatinib through the radiation. The time of imatinib is rather short and stopping poses a risk of CML coming back with the fact that molecular remission is iffy. Kanti Rai
How would you approach radiation to a thoracic tumor adjacent to an aortic dissection?
Address the aortic dissection and treat the tumor if the patient survives.
What adjuvant radiation modality would you select for a grade 2 endometrial cancer with small nodule in the fallopian tube?
She would get chemotherapy for stage IIIA disease. For RT, in the past, used to offer EBRT after chemotherapy but now, if surgically staged with nodal assessment, would favor brachy alone.