Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Has there been an observed interaction between ACE inhibitors and development of angioedema in a block demarcated superficial radiation therapy treatment volume (ex. lip)?
Angioedema may occur at any time during treatment with ACE inhibitors and may even continue after the medication is discontinued. While there is no direct evidence that radiation therapy alone triggers angioedema in patients taking ACE inhibitors, if the radiation therapy affects the tissue where an...
How do you justify adjuvant radiotherapy in pancreatic cancer?
Even though it was flawed in every imaginal way, ESPAC1 had a high impact and made post-op chemoradiation experimental. Prior to that, radiation was not based on very much evidence. GITSG was a 40-patient positive study; the EORTC trial was negative. After the ESPAC1, the focus shifted to neoadjuvan...
Would you offer pelvic re-irradiation in the setting of locally recurrent anal cancer in the presacral region?
Re-irradiation is always tricky. I don't want to miss a chance to help someone, and I really don't want to hurt someone. With re-irradiation, the devil is in the details. If it is small, in a spot where symptomatic toxicity is less likely, and a long period of time has passed since the original chem...
If a patient with non-metastatic prostate cancer is found to have a BRCA mutation, should this influence treatment recommendations for local therapy?
While there are no randomized trials to address this question, one prospective, non-randomized study of BRCA2 carriers with localized prostate cancer suggested improved outcomes with lower relapse rates in men treated with radical prostatectomy as opposed to radiation therapy. See: Castro et al., Jo...
What is the role of postoperative radiation therapy after complete resection of a high grade spermatic cord sarcoma?
I agree with the previous answers to the extent that the role of radiation therapy in this disease entity is not established, as there is no hard data on which to base a decision. But I would recommend radiation therapy in this situation while providing the appropriate caveats to the patient as to t...
For unfavorable intermediate prostate cancer in elderly patients, would you consider radiation without ADT?
This is a great and highly clinically relevant question that I view has 4 important inter-related points.First, I will take the liberty of rephrasing the question as I believe the real question is... for a man with a good enough life expectancy to warrant curative intent RT, does age and comorbid co...
In which scenario would you prefer use of passive scatter proton therapy over intensity modulated proton therapy?
During my fellowship 5 years ago, the training I received was that passive scatter had sharper beam penumbra than pencil beam scanning, due to the use of a brass block (think like an electron cone) closer to the patient. However, I think that the final margin width or total volume treated is more im...
When do you initiate androgen deprivation therapy for biochemical relapse of prostate cancer following primary therapy?
There is no right or wrong answer here. The Johns Hopkins approach is to always recommend a clinical trial for the nonmetastatic BCR population. In the absence of a trial, our group does not believe that early ADT is justified in men with PSADT >9 months, where metastasis-free survival approaches 10...
For those rare patients now out 5 years post GBM treatment and continuous Optune, is there a point one would stop Optune?
I haven’t seen any data from Optune on these very long term survivors. They have released some subset data that patients who used the device 90% of the time or greater had a 29% chance of being alive at 5 years which is pretty remarkable. Certainly think there are diminishing returns beyond 5 years....
How do you approach the management of a patient with lumbar spinal metastasis with neurologic symptoms but without evidence of spinal cord compression?
From the brief description included, it appears that the lesion is at the level of the cauda equina, a group of nerves and nerve roots stemming from the distal end of the spinal cord, typically levels of L1-L5, and contains axons of nerves that give both motor and sensory innervation to the legs, bl...