Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat stage I head of pancreas adenocarcinoma in an older patient who is not a candidate for chemotherapy or surgery?
The question of how to manage an elderly patient who is not a candidate for chemotherapy or surgery is a really important one. I would argue that this question is not unique to an elderly patient but should be asked for ANY patient who cannot receive systemic therapy. We are fortunately living in a ...
How would you approach treatment for a cT1N0M0 urothelial carcinoma of the ureter, high grade in a non-surgical candidate due to medical comorbidities?
Although there is limited data using radiation therapy or chemo-radiation in UTUC, in a non-surgical candidate, this may be a reasonable approach to consider in selected patients. This would be an extrapolation from the promising data from RTOG 0926, a single arm, phase II trial investigating trimod...
Is there a role for radiation in palliating malignant small bowel obstruction?
This problem has similarities to the management of symptomatic brain metastases. In both cases, cancer has caused a buildup of pressure in a vital organ. In both cases, it would be important to take non-radiotherapeutic measures (steroids in the case of brain mets, upstream decompression for SBO) to...
Would you treat a patient with XRT after local recurrence after prostate cryoablation?
We have a strong urologic local therapy program at Duke, and consequently, we see local recurrence after cryotherapy and HIFU. I can say that in my experience these patients tolerate radiation similarly as those who have not had previous prostate therapy, although based on what little data is availa...
How would you manage a new suspected brain metastasis in a patient with a distant cancer history?
So I think there are some details missing but generally, if there is a suspected brain metastases in a patient with distance cancer history and that biopsy/resection is not feasible, I would consider additional workup including extracranial imaging. If the suspected brain metastases is asymptomatic ...
How would you suggest to radiate a Kaposi's sarcoma?
Although you already have some excellent answers, I would like to add a note about Non HIV KS of the feet and hands (so called endemic variety) as sometimes seen in older men of Mediterranean origin. The challenge in this situation is to offer a therapy that produces durable control w/o serious toxi...
Do you recommend concurrent or sequential radiation and chemotherapy for margin-positive, node negative NSCLC?
We recently looked at outcomes with sequencing of PORT and chemotherapy in patients with pN2 disease and R0, or pN2 R1/R2 resection in the NCDB (J Clin Oncol 2017 Dec 13:JCO2017744771). This group is not exactly the pN0 patient population that is the focus of this question, however, in the R0 pN2 gr...
What is your strategy for treating headaches in patients with history of brain tumor?
Not all headaches in patients with brain tumors arise in the context of elevated ICP, but there are other mechanisms (dural irritation, traction on blood vessels, post-craniotomy pain, for example) by which they can be related. If the headache otherwise seems migrainous, I would treat it as migraine...
Have the final results of the OPERA trial changed the way you approach organ preservation in rectal cancer?
Great question. The OPERA results were certainly promising with 3-year organ preservation rates at 97% for tumors less than 3 centimeters. Patients neither received TME nor doublet chemotherapy (no oxaliplatin). Importantly, it was also the first randomized trial showing a higher dose of radiotherap...
Would you consider post operative boost radiation for positive margin in a patient with rectal cancer who underwent short course RT (25 Gy in 5 fractions) prior to TME?
I realize this is a controversial question, but no I would not. There is no way to know if the cells present at the margin are clonogenicly viable or not. If you look at the results of the Dutch TME trial and the MRC CO 7 trials, patients with positive margin after short course radiation had around ...