Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Which genomic test do you use when considering active surveillance in prostate cancer?
As a prologue, molecular expression features, often grouped into "panels" with mathematical models for outcome estimation, can be useful to help patients and clinicians determine whether historical (often still standard) clinicopathological features don't under- or over-estimate risk of clinical sig...
Would you consider salvage SRS in a young patient with locally recurrent ATRT?
Radiotherapy plays an important role in the curative management of ATRT.[Chi et al, JCO 2009; Reddy et al JCO 2020].When relapse occurs, even if it is local, the overall prognosis is often poor. However, I am assuming that this was previously treated, and I would consider re-irradiation with SRS as ...
How do you manage a hemorrhage from a cavernous malformation following SRS?
As the evidence for benefit or irradiating AOVMs is circumstantial at best, I am referred quite a few. Bleeding after treatment would be managed on a case-by-case basis but would often be expectant and would not be influenced by the prior SRS. I would personally not re-treat an AOVM — especially the...
Would you recommend consolidative RT for an HIV-positive patient with Stage I bulky DLBCL of the mediastinum s/p R-EPOCH?
The simple answer is that for most bulky limited-stage DLBCLs, I would favor consolidation ISRT (Preferred per UpToDate and +/- per NCCN). Some support for consolidation RT for bulky DLBCL after modern regimens incorporating rituximab comes from the following: A comparison of patients not receiving ...
In a patient with a pT3N0 rectal adenocarcinoma, would you consider omitting nodal RT and treating only the rectal bed with adjuvant chemoradiation therapy when a large number of nodes have been removed and all found to be negative?
If the decision has been made to treat the patient with adjuvant chemoradiation, I would treat the nodal regions as well as the primary operative bed, as has been done in the seminal trials on rectal cancer. The value of radiation is in preventing a pelvic recurrence that would be hard to salvage. T...
How do you approach a patient with metastatic rhabdomyosarcoma complicated by sinusoidal obstruction syndrome (SOS) after neoadjuvant chemotherapy and radiation therapy?
This is a challenging and unfortunate complication of therapy. Based solely on the information provided and with only 3 fractions left, it sounds like the patient received the majority of radiation therapy, and I would forgo the remainder despite the recovery on defibrotide. However, I would conside...
For locally advanced rectal cancer, would you consider utilizing the RAPIDO trial approach of short course radiation followed by neoadjuvant chemotherapy prior to surgery?
RAPIDO trial is an important study since it is the first phase III study that reported final results of a total neoadjuvant treatment (TNT) approach for rectal cancer.The RAPIDO study is a European study and we need to be aware of the practice difference (in the US, we traditionally use neoadjuvant ...