Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer partial breast irradiation for a patient who otherwise meets PBI guidelines but has a PTEN mutation?
I would say increased risk of new primary in residual breast tissue, like BRCA mutation, and for that reason would recommend whole breast over APBI.
Do you still recommend SBRT for oligometastatic and oligoprogressive breast cancer after the abstracts of the BR002 and CURB, respectively?
"Absence of evidence is not evidence of absence." The negative trials have put a damper on enthusiasm for these patients. This is interesting in light of past training and thinking where breast cancer patients with solitary or few metastases were thought to be emblematic of those that we could poten...
When is it necessary to boost the chest wall scar post-mastectomy?
Theres is no easy answer to this question, and utilization of scar boost varies across institutions based on preferences and interpretation of scant data. Notably, the original ASCO guideline on PMRT explicitly stated that there was insufficient data to say anything about using a scar boost (Recht, ...
What are your top takeaways in Medical Oncology from SABCS 2024?
I would give the following studies the top 3 in terms of impact: GS2-12:The PATINA study, that tested the use of palbociclib in patients who were on maintenance first-line therapy after induction therapy for metastatic HER2 and hormone receptor-positive breast cancer with taxane or vinorelbine plus ...
How do you approach post-operative SRS for resected brain metastases in the presence of residual disease?
I try to dose-escalate to gross disease, based on first principles. Of course, there is not exactly a standard dose and fractionation for SRS/SRT, so judgment is in play for each case based on size, location, and maybe histology. Still, homogeneity is not a priority for SRS, and it makes sense to pu...
Is pre-treatment nodal ultrasound evaluation necessary if a patient undergoes upfront PET/CT for staging?
The answer to this question depends greatly on the local capabilities to conduct regional nodal ultrasound. If this can be done, then we find ultrasound to be very helpful. In today’s environment, it is difficult to obtain insurance approval for PET in the staging of node-positive breast cancer. Bey...
Is it possible to use radiation to treat Morton's neuroma in a patient who continues to have symptoms after steroid injections and alcohol ablation?
I just got a consult for this very diagnosis. I've been treating a lot of arthritis/tendonitis/bursitis in the past 2 years, and since MN is also an inflammatory condition, I am going to treat it similarly. Did you end up treating your patient?
How should verrucous carcinomas of the head and neck be managed?
This is a very interesting question. Most of the data and information regarding the management of this entity is obtained from case series and small retrospective series. There are 3 main issues to consider with regards to the use of radiation therapy for verrucous carcinomas of the head and neck. C...
How would you approach local therapy (surgery or RT) in a patient with radiographic complete response after chemoimmunotherapy for non-small-cell lung cancer?
Only 1/96 patients (0.6%) of patients on CheckMate 816 had a complete response by RECIST so I don't think our current paradigms are really driving these kinds of responses. Additionally, there is clearly a disconnect between clinical response rates by RECIST (0.6%) and pathologic complete response (...
How do you manage a recurrent brain metastasis in a surgical cavity that contains mixed radiation necrosis and viable tumor in the setting of prior SRS?
This diagnosis is made at our center by combining MRI, MR perfusion, and PET data. Management depends on the presentation of the patient, if there is mass effect and/or neurological deficit then surgical re-resection is preferred. As a matter of interest, the pathology on the infrequent resections d...