Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What can prostate patients do for sexual function while on ADT?
While libido drops for most men on ADT, sexual function is still an important component for many, and educating on what to expect will help prevent disappointment or confusion. First, some men can get an erection with testosterone suppressed, but it is less common and not as firm an erection as wha...
Should prostate cancer genomic classifiers, such as Decipher, be used in all high risk post-prostatectomy patients to risk stratify patients to adjvant RT vs PSA observation and possible salvage RT?
I think that the data are hypothesis generating and can assist in physician decision making. Additional analysis from other independent cohorts substantiate the findings from the JCO paper whose publications will be forthcoming. It is important to discuss the findings, including the limitations, wit...
How do you approach treatment for patients with ALK+ mNSCLC who have multifocal or leptomeningeal CNS progression while on first-line targeted therapy?
Leptomeningeal disease is one of the more challenging scenarios to manage in a patient with ALK rearranged lung cancer. One must work carefully with the radiation oncologist and factor in imaging findings as well as patient symptomatology to make the best decision moving forward. Radiation options i...
Do you recommend omitting radiation therapy in young women with favorable DCIS?
If someone can get a screening mammogram, diagnostic mammogram, image-guided biopsy, segmental mastectomy, entertain a conversation about 5 years of ET, they can most certainly handle 5-15 days of PBI where the grade 0 toxicity rate is exceedingly high. Whole breast RT with the Whelan regimen is als...
In a clinically node negative early stage breast cancer patient who underwent neoadjuvant systemic therapy, would surgical finding of fibrosis suspicious for treatment effect in sentinel nodes impact your RT decision?
I would treat breast only for most of these patients with favorable early-stage disease. More so with B-51 not showing benefit even in clinical positive becoming negative.
How do you approach ITCs in sentinel lymph node biopsy in a vulvar cancer patient?
If only SNLN bx is done, then based on GROINNS data, there is a 5% risk of additional node. Since nodal recurrences have a low salvage rate, I would treat with adjuvant RT.
How would you deliver whole breast radiotherapy in someone who cannot raise their ipsilateral arm above their head due to recent shoulder replacement surgery?
Sometimes this comes up. If related to axillary surgery, I will often send to physical therapy/breast therapy and delay simulation for a few weeks. However, there are some cases where there is a preexisting shoulder issue. In these cases, I try to have arm akimbo and will consider VMAT whole breast ...
How do you manage focal DCIS in mammoplasty specimen?
There is uncertainty in these pts as volume of disease and margin status is not known. but if it is focal and low to intermediate grade then observation with antiestrogen is also reasonable If treat would offer hypofractionation course .
How do you approach treatment of a recurrent low grade glioma several years removed from prior radiotherapy?
It's hard to tell based on the question, but assuming the patient still has a LGG on recurrence and a high grade transformation hasn't taken place, it can be reasonable to re treat to full dose 45-54 Gy (assuming can meet dose constraints to normal structures). Factors to take into account are IDH m...
Have you seen an increase in rectal spasms with short course vs long course radiation for rectal cancer?
The side effect profile is very different with 25/5 RT vs long course CRT. There is no question that 25/5 is “easier” to finish, because the side effects almost invariably start after the last fraction. The acute toxicity of 25/5 is after treatment and, as mentioned above, includes spasm, sensation ...