Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there any evidence for combining surgery and XRT +/- ADT for treatment of localized high risk prostate cancer?
Presumably, this is a question inquiring about planned post-operative RT. If so, surgery followed by adjuvant, post-operative radiation therapy (PORT) has been profiled extensively in several RCTs: EORTC 22911, SWOG 8794, ARO 96-02, FinnProstataX. The two more recent trials, ARO 96-02 and FinnProsta...
How do you approach a patient with a solitary brain metastasis from small cell lung cancer s/p resection with otherwise limited thoracic disease?
This is rather an uncommon situation but can happen if a patient presents with a synchronous solitary brain metastasis (with or w/o symptom) and undergoes craniotomy and resection only to find out that it is small cell lung cancer. Additional information is needed on the volume of intra-thoracic dis...
How would you treat a patient with newly diagnosed ALK+ Stage IIIB non-small cell lung cancer (NSCLC)?
Stage IIIB encompasses T3-4N2 and T1-2N3, so I will assume that we are not going to consider a neo-adjuvant approach. Standard treatment for stage IIIB ALK+ NSCLC would be definitive concurrent chemo/RT given with curative intent. Reasonable chemo regimens would be weekly carboplatin plus paclitaxel...
Does being on maintenance pembrolizumab change how you manage patients with partial metabolic response on PET/CT 3 months after chemoradiation for cervical cancer?
No, a good percentage of patients will not have a complete response by 3 months. Six months seems to be a reasonable cutoff. Persistent disease at 3 months does not seem to be a worse prognostic factor than completion at 6 months. At the 3-month mark, I would not manage differently. At 6 months, I w...
Can SRS be used to treat an atypical meningioma?
I agree with @Dr. First Last, and approach patients with atypical meningioma in the same fashion, preferring IMRT to SRS. Indeed most publications have used fractionated external beam therapy, but several centers have published results with SRS. I encourage anyone to have a close look at these. The ...
Do you recommend treatment of the entire extent of the hardware and/or bone when treating a bone metastasis that has received pre-irradiation surgical stabilization?
In the era where imaging like MRI, CT scan, or PETCT is routinely performed, we have not been chasing entire hardware and only treating image based disease with a generous margin. I would not worry about microscopic disease along the entire hardware when the goal and endpoint is palliation.
In what situation would you obtain an MRI before adjuvant or salvage RT to the prostate bed?
In my response, I will assume that the your treatment planning is CT based, as would be the case in most centers, including mine. In the adjuvant setting, I do not get MRIs, since by definition the PSA is undetectable and I do not feel that an MRI will give you useful information beyond what you wou...
Do you have a size criteria when treating lung oligometastases with SBRT?
A lesion 3-5 mm is difficult to characterize on PET, low yield for a biopsy, and non-specific, even if it developed in interval scans. Multiple 3-5 mm lesions could also be from an infectious/inflammatory condition. If the lesions are likely from cancer (i.e. new lesions with rising tumor markers, o...
What is the role of adjuvant radiation therapy for stage III melanoma in the era of adjuvant Opdivo?
I think the role of adjuvant radiotherapy in stage III cutaneous melanoma is difficult to define at this time (June 2019). To be clear, the TROG trial mentioned above showed that adjuvant lymph node basin radiotherapy after therapeutic lymphadenectomy can decrease the chances of lymph node basin dis...
Do you offer LDRT for psoriatic arthritis, rheumatoid arthritis, or polymyalgia rheumatica or fibromyalgia?
I have treated for RA and PA. I have not had any referrals for PMR or fibromyalgia. I have not considered for fibromyalgia, as I don't understand the condition well. For RA/PA, in many cases, they have not had any relief from medications, therapy, NSAIDs, and relying on opioids and other, at times, ...