Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you utilize tumor treating fields in patients with anaplastic pleomorphic xanthoastrocytoma (PXA) III?
I would, but I haven't actually had the opportunity. With more information appearing that TTF is effective in brain metastases, mesothelioma, and pancreatic cancer, why wouldn't you use it if you didn't have a better option? The only real risk is financial.
How would you approach surveillance imaging for men with early-stage, hormone receptor-positive breast cancer after unilateral mastectomy?
As always, appreciate others' input. If you're referring to systemic imaging, I do not obtain surveillance systemic imaging as part of surveillance for any patient with early-stage hormone-positive breast cancer (male or female) unless there are symptoms or initial labs that suggest possible metasta...
Is it ever acceptable for high risk prostate cancer patients to be treated with upfront radical prostatectomy?
This is an excellent and timely question. There is definitely an increasing trend of patients with high-risk prostate cancer (PCa) receiving upfront radical prostatectomy (RP). Some of this is spurred by a recent, high-profile meta-analysis (https://www.ncbi.nlm.nih.gov/pubmed/26700655), which poole...
How do you apply brain metastasis velocity in the clinic?
Brain metastasis velocity is calculated by the number of new brain metastases since initial SRS, divided by the time in years of developing those brain metastases. Less than 4 per year is considered low, 4 to 13 per year is considered intermediate, and more than 13 brain mets in a year is considered...
When a patient with pancreatic cancer received neoadjuvant chemo + chemo-RT, how do you manage an in-field, post operative positive margin?
The data from MD Anderson indicates that patients have a similar survival duration when they have an R1 resection after chemoradiation as when they have an R0 resection, and longer than expected with a positive margin. The Mayo Clinic also has data in rectal cancer where there may be an increased ri...
How do you manage fatigue in women receiving chemotherapy/hormonal/radiation therapy for breast cancer?
Managing fatigue is challenging for patients undergoing cancer therapy. One of the best ways to increase energy is to exercise. It is a bit of a catch 22, but if you explain to patients they can start out with small goals and there symptoms will improve that can help. A very important contributor to...
What are your target volumes and dose for recurrent atypical meningiomas that have been initially treated with definitive surgery alone?
These questions get to the bottom of several important issues facing patients with WHO grade II meningioma and physicians treating them. Permit me to approach these inquiries as if writing a Scientific American article, answers first, then some abbreviated supporting documentation. Regarding treatme...
Would you add whole-pelvis radiation as MDT (metastasis-directed therapy) in a patient with 1 pelvic node and 2 osseous metastatic sites for castrate-resistant prostate cancer?
This patient would not fit the PEACE V-STORM eligibility criteria, since the trial excluded patients with distant metastases and did not include patients who were castrate resistant, so I do not think you can extrapolate the results to this patient. One could argue that what you propose to do (SBRT ...
For resected oral cavity squamous cell carcinoma with indication for adjuvant radiotherapy to the primary tumor bed, would you routinely include ipsilateral and/or contralateral nodes even with a pN0 elective neck dissection?
Since the question states "routinely", the short answer is yes, but the longer answer is there is much more nuance to this.Some will say no based on Contreras et al., PMID 31246526.It is important though to recognize that this paper is a bit more complex and the details are critical.The question ref...
How would you approach ES-SCLC presenting with small brain metastases that resolve after chemotherapy?
ES-SCLC may respond to chemotherapy, but save for a select few, it’s a palliative disease with, median survival of about a year for responders. Presenting with microscopic brain disease that responds to chemo does not change that. The Slotman report indicating survival advantage has been questioned ...