Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage locally advanced head and neck patients getting definitive chemoradiation who show progression halfway through treatment?
I have seen this twice within the last year. Here is what we did: 1) First patient had high risk cutaneous SCC s/p WLE and neck dissection. He progressed in the skin after surgery when seen for sim, and continued to progress during first week of RT. We stopped RT, started cemiplimab. He had a remark...
How would you manage initially unresectable node-negative pancreatic adenocarcinoma that after upfront chemotherapy achieves a complete radiographic response on interval MRI and CT?
This is an interesting question and, in my experience, something that is not commonly encountered clinically. I will assume here that the patient has no visible sites of disease elsewhere. Still, given that scans are a poor predictor for pathologic response and complete response in pancreatic cancer...
How would you approach re-irradiation to a localized DLBCL of the lower extremity?
Unfortunately I need a few more details to answer this. This appears to be a complicated difficult case. I presume the initial dx was DLBCL of the skin, leg type? Age of the patient? What was the response to R-EPOCH? Was the RT given as consolidation or was there disease present? If so, response to ...
Would you recommend pre-op radiation for an operable recurrent well differentiated retroperitoneal liposarcoma with abutment of the right kidney?
Thank you for this question. Per the STRASS trial (Bonvalot S, Gronchi A, Le Pechoux C, et al. Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019) 11001-11001), preoperative radiation overall did not impact abdominal recurrence free survival. However, in the exploratory analysis, the lipos...
Are you considering SBRT in your prostate cancer patients who had a RP and now have a rising PSA and oligometastatic bone disease?
Yes, we offer SBRT for oligometastatic disease, with a frank discussion of current understanding of the potential benefits and risks. We await results of phase III trials, but smaller trials have been encouraging for a progression-free survival benefit (SABR-COMET, STOMP, ORIOLE).
How would you approach treatment of residual melanoma in situ of the perianal skin?
It sounds like this is a case of mucosal melanoma of the anal canal, with extension on to the perianal skin? Alternatively, this could be a case of true cutaneous melanoma on perianal skin. Further investigations might be helpful to clarify.In either case, this is an unusual situation in this anatom...
Would you give preop chemoradiation to a rectal cancer just above the peritoneal reflection with pelvic nodes seen on imaging?
Yes.
Would you offer postop chemoRT to a patient with pT3N2bM0 rectal cancer and ulcerative colitis s/p prococolectomy with j-pouch creation?
Great question. My answer is probably not but rarely maybe. Given that complete hedge, I will expand on what would influence my decision; the details are everything here. The first thing I would be doing is scrutinizing the pre-operative evaluation to understand how we ended up in this position in t...
How would you approach a patient who is s/p mastectomy with only DCIS in the breast and a large positive sentinel node?
If the patient had SLN only (no ALND), I would offer adjuvant radiation extrapolating from AMAROS. While only DCIS in the mastectomy specimen, nodal involvement suggests foci on invasion. Implant reconstruction may increase the complication profile but would not change my recommendation. Age < 50 wo...
When do you offer adjuvant radiation in addition to chemotherapy for patients with high risk localized gastric adenocarcinoma who did not receive pre-operative therapy?
Would recommend starting concurrent chemo-radiation 4-6 weeks postoperatively, when the patient has recovered from their surgical procedure.The US GI Intergroup trial 0116 demonstrated improvement in both RFS and OS for gastric cancer patients at high risk after surgery (T2-4N0, T1-4N+), who were ra...