Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should SBRT for bone metastasis be delivered daily, or every other day?
Canadian/Australian study gave 24 Gy in 2 fractions on consecutive days and no excessive toxicity was noted.I schedule them daily, but if there is a patient convenience issue, QOD is reasonable.It is very interesting, however - there is conflicting data on the efficacy of QD vs QOD for SBRT for lung...
How do you explain the risks and benefits of palliative radiation therapy to patients with fungating breast masses?
The value of palliative RT in these patients is to dry up oozing and bleeding and RT is very effective in achieving that goal. I have had success in these patients almost all the time and my usual dose is 30-39 Gy in 10-13 fractions.This study gives a prospective dataset for fractionation and pallia...
What is your approach to consolidation for localized small cell bladder cancer after neoadjuvant cisplatin and etoposide?
There is limited data with regard to the best management of these patients. Most data is retrospective and has an inherent bias. That being said, there seems to be a benefit for surgical resection after NAC (Patel et al., 24036236), with RT a consideration if surgery is not an option. In a small ser...
Given the new ASCO guidelines on SNB in early stage breast cancer, how does the omission of SNB in patients aged 50-70 impact your adjuvant radiation recommendations?
If the patient is otherwise a good candidate for APBI (age > 50, pT1 tumor, ER+, HER2 negative, Recurrence score low and intending to take endocrine therapy) that was clinically node negative and ultrasound axilla negative, I feel completely comfortable treating with APBI post lumpectomy with negati...
Do you ever treat cervical nodes above the standard supraclavicular field for breast cancer patients?
In the setting of biopsy-proven supraclavicular or cervical nodal disease, I do extend my fields cranially to include these nodes. I typically include the entire neck level based on head and neck contouring atlases and extend the cranial border at least 1 cm superior to the highest node. If nodes ar...
What factors do you take into account when deciding the length of adjuvant temozolamide in GBM?
The field is evolving from 12 cycles to 6 for IDH-wildtype GBM in recent years, on the basis of some retrospective studies and notably the prospective Spanish study GEINO 14-01 - there does not seem to be much OS benefit, and there are also toxicity concerns (myelosuppression, hypermutation). Extens...
What treatment sequence do you follow for patients with rectal cancer who are candidates for both PROSPECT and TNT/Watch and wait?
Thanks for this question. I am not sure whether this is up to us. This is up to our patients to choose which modality they would like to omit (radiation vs surgery). I would point out that a good quality MRI rectum should be performed to r/o any T4/N2 disease or potential requirement for APR. Otherw...
How would you approach post-op radiation recommendations in patient who had neoadjuvant chemotherapy for locally advanced oral cavity cancers (oral tongue) who have a complete pathologic response (pCR) after surgical resection?
While randomized studies of induction chemo followed by local therapy compared with local therapy alone in the 90’s were all negative, it was clear that responding patients did better than non-responding ones. An example is a study (Licitra et al., PMID 12525526) of quite advanced oral ca randomized...
How would you manage a young patient with Sjogrens disease with extranodal marginal zone lymphoma involving bilateral parotid glands with bilateral cervical lymphadenopathy?
For patients with low-grade NHLs (e.g., follicular lymphoma, marginal zone lymphoma), staging dictates treatment. If a patient has a localized process (e.g., contiguous stage I-II disease), then a definitive course of RT is typically recommended. The conventional approach is 24-30 Gy, though a dose-...
Would you continue cemiplimab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma treated with downstaging immunotherapy?
This is a challenging question because, as you know, we have no randomized data to address it. I generally do not continue immune checkpoint therapy after resection of SCC skin. However, given the adjuvant data in melanoma and the high efficacy of anti-PD1 in skin SCC, I do think it is reasonable to...