Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When would you offer definitive or adjuvant RT for solitary fibrous tumor or hemangiopericytoma in the head and neck?
Incompletely resectable or close or positive margins
How would you manage out-of-field nodal recurrence of NSCLC post definitive CRT and adjuvant immunotherapy?
Systemic therapy if distant disease. Radical chemoRT followed by immune therapy if solitary recurrence.
Have you seen any increased dermatologic toxicity with whole breast or chest wall radiation if patients have received recent or concurrent pembrolizumab?
In the KEYNOTE study which established pembro as SOC, they did report small but numerically increased (3.8 vs 1%) grade 3 skin toxicity in pembro arm vs placebo. That’s why the guidelines say it’s safe to administer IO with RT as the above protocol after amendment allowed concurrent IO plus RT.Meatt...
For a patient who has T4 squamous cell esophageal carcinoma on imaging, and who has biopsy-confirmed disease in an involved local lymph node, are EUS or EGD still indicated to complete workup?
EGD will help better define the mucosal extent of the disease. EUS would not help much but if upper thoracic, bronchoscopy may help to rule out invasion.
Do you use an age cutoff for prostate brachytherapy?
There is no age cutoff (low or high) to define the appropriateness of brachytherapy.
What dose and fields would you use for basosquamous carcinoma/basal cell carcinoma of the vulva s/p WLE but not fully excised due to adhesion to the rectum, with no further surgery offered?
If pure basal cell, I would focus on the primary only.
Would you treat the mandible if the patients has osteonecrosis from zoledronic acid but also multiple myeloma in this region, biopsy proven?
Plasma cells can be seen in mandible biopsy without myeloma in that region. Have had a similar patient. However, if the patient has confirmed myeloma relapse elsewhere or systemically then would treat relapse with chemo. Denosumab or zometa is contraindicated due to confirmed osteonecrosis. Not sure...
Would you consider re-irradiation in the setting of prior salvage prostatectomy after prostate brachytherapy?
I would not offer further local therapy in this situation, especially given that there is no direct evidence of disease within a usual post-operative treatment field. I would be very concerned regarding the potential of serious morbidity resulting from further radiotherapy, especially considering th...
Would you offer whole lung radiation therapy in a head neck patient who relapsed with multiple lung only mets?
I would definitely not do WLI in this scenario, refer to Med Onc for systemic therapy. Makes perfect sense to consider SBRT or limited resection if there's only limited biopsy proven disease or a persistent lesion despite systemic therapy, as stated in the much more eloquent and detailed answer abov...
What would be your approach to the treatment of limited stage extrapulmonary small cell carcinoma of the nasopharynx with bilateral cervical lymphadenopathy?
Rare entity and not a whole lot of evidence to base treatment decisions on. That being said, at least make sure a brain MRI has been completed (I know this seems obvious, but just in case).If the patient was in good shape, I would treat with concurrent CRT based on a series out of Japan. Whether to ...