Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of salvage radiation therapy in patients with locally recurrent Hodgkin lymphoma after an autologous stem cell transplant?
How best to employ radiation therapy in patients with Hodgkin lymphoma (HL) who progress after autologous stem cell transplantation (ASCT) is not entirely clear. Often such patients are considered for an allogeneic stem cell transplant, typically utilizing a non-myelablative conditioning regimen. Th...
Should durvalumab consolidation still be offered to Stage III NSCLC patients with PD-L1< 1%?
This is an extremely important question, but basing therapeutic decisions on this post-hoc, exploratory analysis is fraught with hazard. Still, the absence of OS benefit in this cohort (the HR heads in the wrong direction) gives me pause. For those with PD-L1 expression of 1% or higher, I enthusiast...
How would you approach adjuvant radiation therapy for a Merkel cell carcinoma of the cheek in an immunocompromised patient?
Merkel cell carcinoma, as previously discussed, is an extremely insidious and deadly malignancy, usually extending beyond what appear to be negative clinical borders. The fact that this patient is immune compromised has probably led to the development of skin malignancies, but otherwise will not pla...
What is your approach to a patient with a glioblastoma who cannot have an MRI?
We used contrast enhanced CT. Surveillance was done with the same. We were able to provide both post operative adjuvant RT and also stereotactic radiotherapy after localized recurrence. The PTV volume was postoperative cavity and contrast enhancement with 2 cm for adjuvant (single phase) and area of...
What lung constraint do you use when delivering SBRT for local failure of early stage NSCLC following surgery?
We treat these patients in very similar fashion as a primary early stage NSCLC. Provided that the target volume is well defined, does not directly involve the proximal bronchial tree, and in these post-operative cases does not involve the pulmonary vascular hilum we would typically treat with SBRT. ...
Would you recommend adjuvant radiation to the chest wall and/or regional lymphatics after a resected chest wall recurrence?
Absolutely, would treat chest wall and RNI including IMs in most cases
How would you treat an SCC of the helix of the ear with posterior auricular nerve involvement s/p surgical resection?
MR to look for PNI. Likely negative if asymptomatic. CT to look for nodes. Postop RT depends on symptoms and MR and CT findings. If N0, electively treat nodes.
Is there a risk of severe radiation toxicity for a patient with paraneoplastic dermatomyositis due to lung cancer?
One of the treatments for paraneoplastic dermatomyositis is treatment of underlying malignancy which can lead to remission of dermatomyositis in some. I would treat with definitive intent with RT and a few pts I have treated have had improvement of their symptoms with regression of cancer
How would you sequence SRS for brain metastases for a patient receiving dual immunotherapies?
To be honest the strategy in this regard at our center has been haphazard at best. I have not seen any adverse effects that could be clearly related to concurrence of combination dual immunotherapy therapy and GK SRS.My colleague Marc Ernstoff reported results of the Checkmate study which clearly po...
Would you include any elective nodal stations for cases of T3/T4 node-negative NSCLC staged by PET/CT in which a patient cannot undergo nodal sampling?
In short, my answer is “noâ€. I do not target elective lymph nodes for NSCLC patients receiving definitive RT. There are now a few RCTs for locally advanced NSCLC indicating that elective nodal irradiation can be omitted from concurrent chemoradiotherapy (Yuan et al [PMID 17551299], Nestle et al ...