Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage a twice-recurrent mucinous adenocarcinoma of the lower eyelid with direct involvement of the lateral rectus muscle and lacrimal duct?
These are difficult cases. In the past, I have successfully treated a couple of these tumors with neoadjuvant immunotherapy, which allows for reduction in tumor volume to allow for an eye-sparing surgery. Because the orbit is involved, radiation should not be given due to the profound complications ...
Do you recommend irradiating the remaining penis and pelvis vs pelvis alone in a patient with partial penectomy with negative margins who has multiple, positive groin nodes with ECE?
Generally agree with the comments by Dr. @Dr. First Last. The NCCN guidelines tend to recommend chemotherapy followed by node dissection without planned radiation. Post op XRT is reserved for certain situations (which is very toxic after groin dissection ). I have found that treating the penile stum...
Is there a scenario in which you would consider neoadjuvant radiation for rectal cancer after previous definitive radiation for prostate cancer?
I am inclined to refrain from administering neoadjuvant radiation therapy for rectal cancer in a patient who has previously received definitive radiation therapy for prostate cancer. Instead, for these individuals, neoadjuvant chemotherapy followed by surgery appears to be a more suitable course of ...
Would especially young age (eg 20's) influence your recommendation for breast conservation vs mastectomy in an early stage breast cancer?
For younger patients, as with older patients, the final recommendation is influenced by the discussion of risks and benefits. I have treated women in their 20's with BCS+RT as well as post-mastectomy RT. For those electing BCS, the evidence clearly points to a higher risk of local relapse in younger...
Would you offer prostate SBRT to a patient on a TKI?
I would assume the patient is on a TKI for another malignancy such as RCC, and the question is about treating localized prostate cancer.I ask the medical oncologist for input, and if they agree, I will hold TKI for 3-5 days before and one week after SBRT.This is based on the favorable safety profile...
How does Decipher score inform your practice for treating pelvic nodes in otherwise favorable intermediate risk prostate cancer?
Nodal radiation therapy in prostate cancer remains controversial. While the Decipher score correlates with lymph node involvement in pathological specimens, I have not used it to decide on pelvic nodal radiation. Two randomized studies failed to show a benefit to pelvic radiation (old studies with i...
How would you manage a patient less than 40 years old with an incidentally found LGG, IDH mutated, 1p19q intact, s/p STR?
Update: On August 6, 2024, the FDA approved Vorasidenib for IDH-mutant low-grade gliomas based on findings from the INDIGO trial. This decision highlights the FDA's incompetence and lack of scientific integrity, clearly demonstrating that the agency prioritizes pharmaceutical companies' interests ov...
Are there any contraindications to BCS and adjuvant radiotherapy in patients with BARD1 mutation?
BARD1 may be a moderate risk mutation predisposing to breast cancer, but with no contraindications to breast conservation treatment. There may be a slightly increased risk of developing a new primary in the treated breast, much like any other moderate risk gene.
Is there a limit on the number of brain metastases that can be safely treated with single-isocenter multitarget linac-based SRS using HyperArc?
When thinking about this particular question, one would have to define which metrics would be dose limiting. Most would consider a mean brain dose of about 8 Gy to be the maximum tolerated dose to the normal tissue. This could be modeled in HyperArc and is a function of the number of tumors and volu...
In the setting of an atypical lipoma/well-differentiated liposarcoma of the extremity with a small component of dedifferentiated liposarcoma, is it necessary to treat the entire mass with neoadjuvant radiotherapy OR just the dedifferentiated component that is enhancing on contrast MRI?
When treating these well-differentiated liposarcomas, I would treat the entire mass to the preop dose of 50 Gy in 25 fx. Although there may be visible areas of dedifferentiated on MRI, there may be other areas that are not visible on imaging, and thus treatment of the entire mass would be warranted....