Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider adjuvant radiation for a patient with recurrent pelvic node melanoma s/p immunotherapy and pelvic lymph node dissection with complete pathological response (only necrotic tissue; no viable melanoma)?
At this point, no. These patients seem to have a low risk of recurrence if they experience pathologic complete response following neoadjuvant immunotherapy.
Would you ever start adjuvant pelvic radiation with a drain in place?
I wait for the drain to be removed as it’s in the target location.
Do you offer APBI to patients with close margins?
If otherwise suitable for APBI, we follow no tumor at ink as negative margin.
Do distant lymph nodes from metastatic prostate cancer (retroperitoneal and SCV) count as oligometastatic disease?
I would treat more like oligopersistence/progression and limit treatment to visible disease only and not the chain.
How would you address squamous cell carcinoma in situ focally present at the bronchial margin after lobectomy?
Rare event so not great data to guide decision-making here. Technically, this is an R1 resection but a positive resection margin due to residual microscopic invasive disease is a distinct entity from a positive margin due to CIS. There is a nice review from JTO that covers this topic (Vallières et a...
For a pedunculated rectal polyp found to be adenocarcinoma after endoscopic removal, with PNI as the only adverse feature, would you recommend additional treatment such as surgery or chemoradiation?
Yes
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.