Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage an elderly female patient with a remote history of synchronous bilateral invasive ductal carcinoma with a new triple-negative recurrence in the left breast and axilla with extension to the contralateral breast?
Unfortunately, if no good systemic options are left including pembro/parp inhibitor then the outcome is most likely palliative. Will try a hypofractionation schedule for palliative/preoperative dose of RT.
How would you approach treatment for a patient with a residual disease after resection of a solitary jejunal myeloblastic sarcoma?
Myeloid sarcoma (historically- chloroma or granulocytic sarcoma) is simply an extramedullary form of AML. The majority of patients who present de novo with a myeloid sarcoma will either have bone marrow involvement at diagnosis or will develop such metachronously if systemic therapy is not pursued. ...
Do you offer consolidative radiation for oligometastatic breast cancer?
I'd like to add a few additional considerations to the already excellent responses from our colleagues. Many of the trials cited actually address two related but distinct clinical questions, and the answer for HER2-positive disease specifically may diverge from the population-level results.Trials of...
What is the consensus on the size of the expansion from the gross tumor volume (CTV) to the clinical target volume (PTV) in treating intact supraglottic squamous cell carcinoma with radiotherapy?
The modern approach for head and neck cancer, based on international guidelines, has been CTV high dose (70 Gy) = GTV + 5 mm expansion (respecting anatomic boundaries and structures not at risk). Some centers in the past and present have also had an intermediate volume where an additional 5mm is add...
When using concurrent hyperthermia with reirradiation, is there any benefit to delivering hyperthermia on non-RT days?
Hyperthermia alone, in the absence of radiation or chemotherapy, is not effective as cancer therapy, notwithstanding occasional reports to the contrary from sources of questionable reliability. Hyperthermia is a very effective sensitizer for both RT and chemo. Note that we are not. discussing high-t...
How would the updated results of ECOG 3311 influence your adjuvant RT recommendations for HPV+ OPSCC?
This question refers to this manuscript (Burtness et al., PMID 40493877), which is a 4.5-year follow-up of ECOG E3311.The results broadly mirror those seen in previous reports. The most notable novel finding reported is that among patients with low-risk features (who did not get any adjuvant RT), th...
What factors do you consider when selecting dose/fractionation for whole brain radiotherapy?
I assume this question is for brain metastases patients who are not eligible for hippocampal avoidance WBRT (ineligible criteria including but not limited to - mets 5 mm within either hippocampus, germ cell/small cell/lymphoma, leptomeningeal disease, etc.) - my default WBRT dose fractionation is 30...
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).
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.
What's the role of contralateral neck re-irradiation in the post-op setting for someone with a remote history of head and neck cancer who underwent definitive RT with elective dose to the bilateral neck now with a new primary s/p surgery with ipsilateral neck dissection requiring post op chemo radiation for bony involvement and ENE?
In a reirradiation setting, I would not offer elective RT. Even if the new primary approached or crossed midline, I would refrain from reirradiating a neck that was subject to prior RT in the 50 Gy range.