Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach early stage NSCLC in a patient who is not an ideal surgical candidate and has pulmonary AVMs?
The standard volumes and flows of PFTs do not assess regional differences in what is perfused and ventilated. V/Q scans do, but their most common use for pulmonary embolism is their most common role. This serves to identify gas exchange near the primary as well as where the AVM’s reside. Target the ...
Do you recommend chemoradiation following neoadjuvant FOLFIRINOX for resectable pancreatic cancer?
Tough question, with lots of evolution in this area in the past few years. The data would suggest that for borderline resectable pancreatic cancer, there is a benefit in terms of OS from preoperative treatment. For unresectable disease, the small chance of conversion into resectability is worth the ...
How would you apply the results of CheckMate 204 in an asymptomatic patient with 10-20 metastatic brain lesions on dual immunotherapy for melanoma?
The results of CheckMate 204 showed that systemic therapy with both nivolumab and ipilimumab has clinically meaningful efficacy in patients with asymptomatic, untreated melanoma metastases to the brain. In this phase 2 study, however, only 22% of the patients had 3 or more lesions. Nevertheless, int...
Are there any trials currently studying low-dose RT for confirmed COVID-19 infections with associated pneumonia?
This is a joint reply from a team developing a prospective trial to answer this question:Minesh Mehta, Arnab Chakravarti, Walter Curran Jr, James Fontanesi, Vinai Gondi, Michael Kasper, Deepak Khuntia, Rupesh Kotecha, Ramesh Rengan, Leland Rogers, Charles B. Simone II, James Welsh, George WilsonThis...
What would your approach be for a locally advanced head and neck cancer diagnosed concurrently with a mid-esophageal cancer?
In the handful of similar cases that I have seen, I have worked with medical oncology to tease out a concurrent chemotherapy regimen. What we have often ended up doing is treating the head and neck cancer as normal (to 70 Gy) and the esophagus cancer to a relatively standard dose (usually to 50 Gy t...
For a patient s/p laryngectomy with positive margins, would you start radiotherapy 6 weeks s/p surgery if there is a delay in concurrent chemotherapy?
The question is a bit challenging without understanding the reason why the patient is suited for XRT but not chemo. My best guesses would be a concurrent infection or PS issues, possibly due to deconditioning after a hard surgery.However, part of the decision would involve when it is anticipated tha...
In p16-positive oropharyngeal squamous cell carcinoma, when induction therapy is considered before definitive chemoradiation, how do you choose between a traditional TPF regimen and carboplatin/paclitaxel/pembrolizumab?
Sequential therapy, as defined by induction chemotherapy followed by chemoradiation, is generally reserved for patients at high risk for recurrent or metastatic disease. The published randomized data offers no improvement in survival with TPF followed by CRT versus CRT. Thus, such an approach can be...
Within what timeframe should adjuvant radiotherapy start for Merkel cell carcinoma of the head and neck region?
I use a 4-6 week post-op timeframe for adjuvant RT for Merkel cell carcinoma. I always prefer closer to 4 weeks, whenever possible.
For an non-operative patient with IB1 cervical cancer, would you recommend RT alone or concurrent chemoRT for definitive therapy?
I usually favor RT alone as local control and the outcome is excellent unless they have adenocarcinoma, a suspicious pelvic node, or multiple high risk features (high grade with LVSI on bx).
In mCRPC patients who had an initial response to Pluvicto but progress within 12 months, where do you position PSMA radioligand retreatment relative to other next-line systemic options in your sequencing strategy?
After Lu-PSMA therapy, we may consider taxane chemotherapy, Ra-223, ARPI, or clinical trials in addition to Lu-PSMA retreatment. Retreatment may be more heavily considered in patients with prior deep response to Lu-PSMA, high avidity on a repeat PSMA PET, and/or limited candidacy for other treatment...