Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What role does radiation plan in a pT1a endometrial cancer with two small metastatic foci in the abdomen found during surgery?
I see the limited value of prophylactic RT here and favor systemic treatment only.
How would you treat locoregionally recurrent anal CA?
Surgical resection is standard of care for isolated locoregionally recurrent anal cancer - if the disease is resectable. Resectable disease includes local recurrence in the anal canal and limited nodal disease (i.e. mesorectal, possibly inguinal). Fixed pelvic side wall recurrence (nodal or direct e...
Would you recommend repeat radiation therapy for a painful perineal recurrence in a patient who failed definitive CRT, and recurred again after salvage abdominoperineal resection (APR)?
I think repeat radiation therapy is certainly an option that can be offered to this patient, especially if the interval between treatments is long. MD Anderson reported on a series of 10 patients with anal SCCs treated with reirradiation after definitive CRT (https://www.ncbi.nlm.nih.gov/pubmed/2775...
How are you approaching patients with early-stage NSCLC who progress on neoadjuvant chemo-immunotherapy and are no longer surgical candidates?
This is a good question, and we are seeing it too often these days. This question cites progression as the reason for not proceeding to surgery after neoadjuvant chemo-IO. We are also seeing patient refusal and ineligibility (i.e. N3 disease that didn't respond) as reasons. I think it's very importa...
How do you manage grade III oligodendroglioma?
Given that these tumors predominantly occur in younger adults, and are often slowly progressive, there is an easy tendency to become complacent about the long-term behavior and outcomes with this disease. The bottom lines with this tumor are as follows: The diagnosis is complex, and often difficult,...
How do you define an adequate EBUS when staging NSCLC?
Important question. There is a high degree of variability in the diagnostic performance of EBUS based pretest probability of disease, physician experience and skill, quality control, and evaluation skills of the cytopathologist. Nice consensus guidelines from CHEST was published a few years back det...
Are there any special considerations when treating a patient with anal cancer who has poorly managed HIV/AIDS?
In the early days of AIDS, prior to the development of HAART, standard chemoradiation ("Nigro") was very poorly tolerated, and it was necessary to omit or dose-reudce the mitomycin, and many patients could not tolerate the full dose of radiation, stopping treatment early because of toxicity. Outcome...
When treating prostate or other pelvic malignancies, what dose constraints do you use for the sigmoid colon?
The data on cervical cancer RT with EBRT and brachy uses same constraints number for rectum and sigmoid (<65 -70 Gy to 2cc) . The corelation of sigmoid dose to toxicity is less as it is more forgiving because of organ moton. Dosimetric number which one reports is worse case scenerio not accounting f...
How do you manage recurrent atypical meningiomas in patients who have previously received radiotherapy?
This question, I fear, requires some underpinning. A recurrent atypical meningioma is an aggressive tumor, more so that than appears to be appreciated broadly. Even between first and second recurrence, as shown in a study by Bagshaw and colleagues at the University of Utah (Neurosurgery 126:1822–1...
How do you treat patients with single/solitary brain metastases who undergo resection after failing SRS?
Because of the difficulty in distinguishing between true tumor recurrence, radionecrosis, and a mixed radionecrosis/tumor recurrence picture, if possible we prefer to approach these surgically. If the recurrence can't be resected, these are patients that are referred for biopsy + LITT (laser induced...