Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What size cut-off do you suggest for the safe administration of SRS in the setting of brain metastases?
The likelihood of radiation necrosis or acute treatment related imaging change does seem to increase with larger lesion size. I get worried once the target approaches 3 cm in diameter but have treated selected patients beyond that out to 4 cm using 15 - 16 Gy. We have an ongoing trial of dose select...
How do you counsel patients with NF1 diagnosed with breast cancer regarding breast radiation?
These patients tend to present with more aggressive breast cancers (higher grade and stage, and higher incidence of contralateral disease). They are also thought to be at increased risk of radiation-induced malignancy (including sarcomatous changes). In addition, screening and surveillance are chall...
Would you offer consolidative radiotherapy for oligometastatic NSCLC?
These are extremely challenging cases and the recent negative studies have somewhat dampened my enthusiasm. It has been challenging, in general, to obtain authorization for treatment in these cases and the release of this data will not make it any easier. And as experts note, there are multiple bin...
Would you offer a patient with “good-risk” DCIS and an elevated DCISionRT score APBI or WBI?
Based on the technical suitability, either option is fine.
How do you manage a glioblastoma of the brainstem/upper cervical spinal cord?
It used to be that we didn’t get biopsies in this location, and we treated suspected astrocytic tumors in the brainstem/upper spinal cord to 54 Gy in 30 fractions without tissue. The outcome was never good. But now we generally have at least a stereotactic biopsy. The outcome is still not good of co...
Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?
From my experience, this is a catch-22. If you stop the Denosumab you will markedly increase osteoclastic activity throughout the entire skeleton which is why it is recommended that you not stop the medication without some other intervention. I have had several patients with either osteonecrosis of ...
How would you approach treatment of an optic nerve sheath meningioma presenting with complete ipsilateral visual loss?
Radiosurgery to prevent further tumor growth of an optic nerve sheath meningioma in a patient with complete ipsilateral visual loss can technically be accomplished. It is prudent to not include the chiasm nor the very proximal optic nerve due to Wilbrand's knee of the optic chiasm (where crossing fi...
What would you recommend for early stage vulvar cancer with close margins?
With negative sentinel LN's in an early stage patient, I would try to avoid the use of radiation if possible. Re-excision with a clear margin of 1-2 cm, extending to the deep perineal fascia, should be adequate to give a high rate of local control and cure, in the absence of other negative prognosti...
What is your preferred radiation technique for treatment of skin cancer of the eyelid?
Beam and internal eye shielding (between globe and eyelid)
Is the phase 2 data regarding neoadjuvant cemiplimab in cutaneous squamous cell carcinoma sufficient to adopt for all patients or will you await phase 3 data?
The current data are quite compelling, but not sufficient to adopt for all patients. We need to see the long-term recurrence and survival rates from the phase II study and also perform a confirmatory phase III trial with a survival endpoint. Unless this treatment approach results in equivalent to im...