Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should other treatment options be considered for MALT lymphoma if the lacrimal gland will be included in the radiation field in a patient with Sjögren's disease?
The orbit is the second most common site of origin for extranodal marginal zone lymphoma (MZL). Involved orbital structures include the bulbar and/or palpebral conjunctiva, lacrimal gland, and periorbital soft tissues. Patients with Sjögren’s syndrome (SS) are at increased risk for developing extran...
Does the choice of radiation modality (3D, IMRT/VMAT, protons) impact the effectiveness of the reduced dose of 20 Gy in DLBCL?
I don’t think modality (IMRT vs 3D vs protons) has an impact on the effectiveness of the reduced dose of RT.
For biopsy proven extranodal marginal zone lymphoma involving two small bilateral lung nodules, would you consider definitive treatment to both nodules with radiation therapy?
It has been observed that many patients treated with radiation therapy for an extranodal MZL in a paired organ (orbital and parotid, in particular) will develop metachronous disease recurrence in the contralateral organ (Goda et al., PMID 20564130). In fact, it is relatively common for patients with...
For stage III-IV Hodgkin's lymphoma, would you consider consolidative radiation for bulky disease after a complete response was seen using N-AVD per the S1826 trial?
I would offer consolidative radiation only for PET-positive residual disease.
Would you include the supraclavicular basin in adjuvant radiation treatment fields if there were multiple positive axillary sentinel lymph nodes with ECE discovered at the time of resection of a proximal arm cutaneous SCC?
Short answer, I wouldn't. I'd do good restaging (PET vs contrasted CT or both) and ensure you're just dealing with microscopic residual or to guide boosting to gross disease dose if gross residual in axilla, and just treat your involved axilla and primary site if indicated. This is a patient who wou...
As consolidative thoracic radiation (cTRT) was prohibited on the seminal chemoimmunotherapy trials in ES-SCLC, how do you approach cTRT in practice?
The data supporting consolidation thoracic radiotherapy (cTRT) after chemotherapy response in ES-SCLC are relatively soft. The phase III Jeremic trial (Jeremic et al., PMID 10561263) reported an overall survival (OS) improvement with accelerated hyperfractionated cTRT to 54 Gy + daily carboplatin/et...
How would you approach a patient with recurrent grade 3 oligodendroglioma (MGMT-methylated, IDH mutant, 1p/19q co-deleted) 1 year after gross total resection and adjuvant chemotherapy and radiation?
There are multiple options to consider for the recurrence of grade 3 gliomas after prior chemotherapy or radiation. Regardless of whether or not the recurrence overlaps completely or partially with the prior treatment fields, options include systemic therapy (including IDH-targeted therapies for IDH...
Are there cases that should be referred to a center with a MR Linac for RT?
There likely are cases that would be best treated on an MR Linac, though I suspect they are relatively few and far between. The categories noted in the question stem are certainly considerations, however, I feel that only a subset of these patients would gain true advantages. MR Linac offers the pot...
Are there any indications to boost the axilla for women with locally advanced breast cancer who do not have clear gross residual/undissected axillary disease?
There is no indication for a boost in absence of undissected gross node for upfront surgery or residual node, which is not removed after neoadjuvant chemotherapy.
What surveillance do you recommend for a patient with locally advanced rectal adenocarcinoma who had a complete clinical response to total neoadjuvant therapy and declines to undergo surgery?
It is important to watch these patients closely since ~15-20% will have local regrowth/recurrence that are salvageable (Dossa et al Lancet 2017). The OPRA trial, recently presented at ASCO 2020, included 324 patients treated with TNT regimens and WW if complete response. Organ preservation rates wer...