Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach a patient with undifferentiated pleomorphic sarcoma encasing the spinal cord post radiation for neurological deficits for further management?
We will need some more information here. Did the patient present with cord compression? What level of cord is involved? Is the tumor causing functional issues in the patient (paralysis, bladder issues, etc.)? What was the dose of radiation used? Was this definitive RT or palliative RT? Is there any ...
Does triple negative breast cancer influence your decision to boost an older patient post lumpectomy?
Yes. The phenotype of breast cancer does predict the risk of relapse in the elderly population as well. For that reason, we would offer a boost in all triple negative patients, irrespective of age. In a recent update of the Toronto–British Columbia (TBC) randomized study for older patients with node...
How would you approach subtotal resection of a sarcoma of the scrotum/groin with grossly positive margin at the base of the penis?
These are clinically challenging situations. I would image to see if there is gross vs. microscopic disease. I would also have a surgical colleague evaluate to see if re-resection is possible to remove gross disease if present and obtain negative margins. With respect to adjuvant radiation, histolog...
How do you consider the role of probiotics for mucositis mitigation in patients receiving head and neck radiotherapy?
This is a very interesting study and I am excited to see continued studies into symptom mitigation for definitive chemoRT. I currently offer Ssk12 to my patients undergoing H+N RT (definitive or adjuvant). I see little potential downside as it is a relatively inexpensive intervention and they report...
Do you evaluate patients for low health literacy prior to discussing treatment options?
To answer this question - I do not routinely evaluate for low health literacy in my patients. This may not be the correct approach, but here is my rationale. I assume low health literacy and work up from there during each consultation. Even patients who are highly educated and/or have a background i...
Would you recommend PMRT in a patient with a triple negative cT2N0, ypT2N0 metaplastic breast cancer s/p NAC, mastectomy, and SLNB?
I would favor it, as these metaplastic tumors are aggressive triple-negative diseases with mixed responses to chemo. In this case, lack of any response and residual of more than 2 cm for this histology, I would favor RT.
What is the optimal management of pain and loss of function due to pathologic compression fractures?
I explain to my patients if they have an acute compression fracture that they are likely to experience pain for approximately 2-3 weeks that will gradually resolve. I often give them some type of pain relief using Tylenol or ibuprofen and if severe, a more potent analgesic for a short period of time...
Would you offer ultra-hypofractionated accelerated partial breast re-irradiation using 5 fractions?
I have favored 40 in 15 or 45 in 30 for now in view of reradiation
Would you recommend radiotherapy to upper-tract urothelial carcinoma in an inoperable patient?
Unfortunately, there are no good data to guide a decision in this circumstance. Assuming that this is a patient with a small tumor localized to the upper tract with no evidence of nodal or distant disease, radiotherapy might be a reasonable option to either palliate symptoms due to obstruction or bl...
What is the best way to treat a small brainstem met with stereotactic radiosurgery?
Small brain metastases in the brainstem can be treated with radiosurgery safely. Typically, the dose is dialed down to minimize the risk of radiation necrosis within the brainstem. At our institution, we typically reduce the dose down by one dose level using the RTOG scheme. For example, a 2 cm or l...