Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
What criteria do you use to decide whether to start anticonvulsants in patients with brain metastases?
Patients with intact brain metastases in the absence of seizure activity should generally not be receiving prophylactic anticonvulsants based on 2019 guidelines from the Congress of Neurologic Surgeons subsequently endorsed by SNO and ASCO. The practice of prophylactic AEDs in the post-op setting is...
What is your approach to reporting mandible dose received to the dentist/oral surgeon?
There are multiple ways to view this question - either as part of the pre-radiation therapy work up, or as information sent along after the patient has received treatment and may need ongoing dental care or procedures performed by an oral surgeon.In the first scenario, we have a form letter that we ...
What is your preferred treatment for Stage IIA seminoma or IIB seminoma with LN <3 cm and normal tumor markers after orchiectomy?
Para-aortic nodal disease <5 cm is well treated with radiotherapy to PA+pelvis with boost tot eh nodes with high cure rates and minimal toxicity. >5cm best treated with BEP or EP chemotherapy. No role for RPLND in seminoma.
What margins do you use for GBM volume delineation?
There is an ASTRO consensus guidelines committee currently working on guidelines for glioblastoma. One of the key questions facing the committee is the optimal target volumes for potentially curative radiation therapy. Issues include treatment of FLAIR/T2/edema followed by a boost to the T1 enhancin...
When following active surveillance paradigm, what PSA increase will trigger prostate biopsy?
When using PSA to aid in the decision to re-biopsy a patient on active surveillance, I think you have to consider that the non-malignant prostate tissue also contributes to the rise in the PSA and that there are limits to the accuracy of the test. In patients not known to have prostate cancer, a PSA...
What criteria do you use when selecting a multi-fraction vs single fraction approach for treatment of spine metastases with radiosurgery?
For de novo spine metastasis, I typically use 27 Gy in 3 fractions as default and use a single fraction approach only for logistic reasons (we frequently have patients coming from Hawaii, Guam, Alaska, Montana, Wyoming, Idaho, and eastern Washington).My reasons for using a multiple fraction approach...
Is it safe to use curcumin during cancer treatment?
There is preclinical data that suggests curcumin is a normal tissue radioprotector and a tumor sensitizer. That is a difficult combination to achieve and I am skeptical. There is also preclinical data that it works on a number of patho-physiologic pathways, some common and other specific to particul...
Should PMRT be offered for ypN0(i+) disease if only 1-2 nodes were removed in the post-chemotherapy SLNB and there is no plan for a completion AxLND?
I favor PMRT although they were eligible for B-51 and called N0. Based on the surgical series, the risk of additional positive nodes is 15% to 57% (SN FNAC phase 2 study) and for that reason, treat with comprehensive PMRT.
How do you approach a recurrence of grade 3 anaplastic astrocytoma after initial treatment with gross total resection followed by RT/adjuvant temozolomide?
As the questioner notes, this is an area where guidelines and published evidence are not as satisfying as we would like, so treatment has to be individualized. In addition, most trials until very recently did not test IDH status or 1p/19q status so the diagnoses may not be the same as people diagnos...