Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a rare presentation of an older adult after gross total resection of an "infant-type hemispheric glioma" of the left frontal lobe, IDH1 negative and negative for MYB fusions?
Infant-type hemispheric gliomas (IHGs) are rare high-grade astrocytic tumors characterized by giant size and abundant vascularity, often with regions of cystic transformation. They are aggressive brain tumors that occur during early infancy, usually between 0 and 12 months of age. They are often ver...
How do you determine the timeline for healing after craniotomy prior to starting chemotherapy and radiation?
I typically wait at least 10-14 days post-op, always after neurosurgery has re-evaluated the craniotomy site for appropriate healing and has already removed staples or sutures.
What is your radiotherapy plan for recurrent midline epidermoid cyst after resection around 10 months ago?
Radiotherapy for suprasellar epidermoid cysts is typically reserved for rare, recurrent, or malignant cases where surgical resection is not feasible. While microsurgical removal is the standard, adjuvant radiotherapy (conventional or stereotactic/Gamma Knife) can effectively manage residual or recur...
Would you offer empiric lung SBRT for two growing FDG-avid lung lesions in a patient with severe COPD on oxygen?
This is a good question! The short answer is yes, most likely. Many patients are too high-risk to receive biopsies; this is decided by surgery/pulm/IR. Unless the patient has contraindications to RT or something like severe IPF (where treatment may be worse than the disease), I would likely offer th...
What is your recommendation for patients who are on weight loss medications like GLP-1-based therapies while receiving chemoradiation for head and neck cancer?
I recommend immediate discontinuation of GLP-1-based therapies. Increased risk of nausea/vomiting and weight loss certainly aren't side effects we need during head and neck chemorads. Additionally, there is concern that these agents, even outside of cancer patients, contribute to sarcopenia, which h...
Is there a scenario in which you would consider observation for T4a SCC involving the mandible?
While PORT is well established, the scientific basis for it is relatively weak in the absence of a randomized trial, as all phase 3 trials have focused on adding something to radiation rather than the benefit of radiation alone. Further, the rationale for PORT historically is if there is a belief of...
How do you approach cisplatin dosing for locally advanced head and neck SCC in HPV-positive and HPV-negative patients?
Weekly cisplatin 40 mg/m² is not yet considered equivalent to high-dose cisplatin 100 mg/m² every three weeks, and high-dose cisplatin remains the preferred regimen for both HPV-positive and HPV-negative locally advanced head and neck squamous cell carcinoma. However, weekly cisplatin is an acceptab...
What is the preferred neoadjuvant/adjuvant chemotherapy regimen for HPV-associated nasopharyngeal cancer?
Let me give more context: Had an interesting conversation with a med onc colleague regarding neoadjuvant or adjuvant gem/cis for HPV-associated NPC. I personally make a distinction between EBV-associated NPC and HPV-associated NPC. My interpretation of the data is that the benefit is only/mainly for...
For unresectable-appearing BRAF V600E papillary thyroid cancer involving the trachea and carotid artery, is neoadjuvant targeted therapy a viable path to surgery, or is definitive radiation the better option?
If the tumor is considered unresectable due to carotid encasement, as is likely in this case, then neoadjuvant targeted therapies should not be considered. Multikinase inhibitors (i.e., lenvatinib) or targeted therapies (dabrafenib and trametinib) will not produce great enough responses to make the ...
How do you approach a patient with indolent, small-volume, but slowly progressive lung mets from sarcoma?
If small volume without active extrapulmonary disease and amenable to addressing all lesions with SABR, surgery, or a combination of both, I would target all lesions with local therapy. If the above conditions are met, these can often be monitored closely with q3-6 month CT surveillance in the prese...