Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you avoid radiation in a patient with breast cancer with active skin lupus?
In a patient with active skin lupus, I would counsel regarding the risks of radiation toxicity based on data available. Based on previous encounters, most patients after discussion of risks/benefits pursue mastectomy. If the patient still wanted to pursue BCT, I would discuss with their rheumatologi...
Would you consider adjuvant radiation in a patient with stage 1 (<1 cm) Merkel cell carcinoma of the lateral upper arm status post resection to negative wide margins?
For a stage I Merkel cell carcinoma < 2cm size, long-term outcomes are good and close surveillance may be reasonable, based on the results of meta-analysis. For those with tumors >2 cm or greater, adjuvant RT can help improve loco-regional control and survival. Additionally, ongoing trials of anti-P...
How would you manage an elderly, medically inoperable patient with high-grade, muscle-invasive bladder cancer who has already received definitive prostate irradiation?
The more patients with prostate cancer we treat and the longer they live, the more likely this is to happen. While cystectomy is the right thing to recommend, it is often a very difficult operation as continent diversions are impossible, and the risk of bowel injury is high. If the patient is elderl...
In what settings would you offer adjuvant radiation for a R1 resected desmoid tumor?
We usually avoid RT for margin positive desmoid unless at a location where surgery for recurrence would be hard like deep seated in pelvic region or involving nerve fibres where implication for recuurence in terms of symptomatology is higher
How do you manage patients without a pathologic diagnosis of malignancy referred for palliative radiation?
If there is great certainty that this is malignancy (i.e. cord compression with a large lung mass) and the patient is unwilling to undergo biopsy, this is still an emergent situation and no treatment would lead to loss of function or life. In this case, it's worthwhile to have a consent written up f...
How would you approach treating a patient who refuses surgery, but has significant residual disease after chemoradiotherapy for squamous cell carcinoma of the esophagus?
IO and herceptin/perjeta/enhertu
Can SBRT be considered for high risk prostate cancer?
There are many ways to address this question:1. The academic "letter of the law" purist: "If a patient population was included within a clinical trial then the trial results apply to them. Subset analyses are hypothesis-generating."By this logic: HYPO-RT PC enrolled about 11% high-risk disease and s...
Are there consensus target volume definitions for craniospinal irradiation following resection for adult medulloblastoma?
Craniospinal irradiation (CSI) continues to play an important role in the management of medulloblastoma and other brain tumors that disseminate through the CSF. Because these tumors are more common in the pediatric population, the guidelines adopted for adults are usually adapted from those used in ...
Do you advise Kegels/pelvic floor physical therapy to minimize urinary incontinence when irradiating the prostatic fossa?
I have not recommended Kegels/pelvic floor PT in asymptomatic patients, but if patients are symptomatic either before, during, or after RT, I will make this recommendation. My preference is to refer the patient to a Physical Therapist or pelvic rehab team with special expertise in this field, but if...
Is there a subset of patients with Paget's disease of the breast in whom you would omit radiation after a central lumpectomy?
I would approach treatment following the same principle as low-risk DCIS. If there's no evidence of invasive or underlying DCIS, I would engage in discussions regarding the potential for radiotherapy or observation, with or without anti-estrogen therapy.