Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you decide whether or not to cover elective lymphatics when treating cutaneous squamous cell carcinoma of the head and neck with definitive RT?
I dont think there's a good, single, validated tool for determining when nodes should be selectively treated in cutaneous SCC. Various sources suggest risk factors for nodal disease - size > 2 cm, depth > 4mm, poorly differentiated tumors, PNI, LVSI, immunosuppression, recurrent disease, and body si...
How do you treat locally advanced medullary thyroid cancer with postoperative RT?
Medullary thyroid cancer typically presents with extensive LN metastases, and this case represents a typical very advanced case. Cases of more localized cancers which I have treated were characterized by adequate control of the irradiated disease, however, in all such patients disease progressed in ...
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...
For a recurrent medulloblastoma in the posterior fossa several years after initial standard risk therapy (23.4 Gy CSI), and in which the patient is still less than 18, how would you approach re-irradiation?
If the recurrences are localized to the resection bed, I would re-irradiate only the recurrences (and possibly the entire resection bed depending on number of recurrences). If there is evidence of CSF dissemination (recurrences not associated with primary--whether in posterior fossa or not) then CSI...
How do you counsel patients with high risk prostate cancer treated with RT + long term ADT who want to allow their testosterone level to rise above castration before receiving their next Lupron injection?
I would not support this strategy unless the patient is on longer term ADT for biochemical recurrence after prior local therapy. In that setting, intermittent ADT is a viable option supported by literature and could be considered. Otherwise, once ADT is stopped, there's no basis for resuming. The co...
How do you manage favorable intermediate risk prostate cancer patients that have a PIRADS 5 lesion that was most-likely missed in the template biopsy?
Yes, I'd suggest a repeat biopsy before treatment. In the case of radiation +/- ADT, a repeat biopsy may impact the dosimetry of radiation, whether or not ADT is used, and how long ADT is used as part of treatment.
How would you approach a localized but unresectable adenoid cystic carcinoma of the distal trachea?
Curative intent RT
In patients receiving concurrent chemoRT for lung cancer, do you have thresholds for cytopenia at which you would hold RT?
Before the cell recovery stuff, which is now falling out of favor I hear, my constraints for holding RT in these types of cases were: * Platelets 20K or less: spontaneous bleeding can occur at this point or lower. * Absolute Neutrophil count (ANC) of 0.5 or less. I know some folks have an ANC cut-of...
How do you manage an elderly, high risk prostate cancer patient who refuses any local therapy?
In general, for patients who refuse treatment, I try to understand their goals and their fears. Often, elderly patients state that they are ready to die, and don't want to prolong their lives. If I think that treatment is likely to significantly improve the quality of their lives, I will explain why...
In an adult with localized spinal myxopapillary ependyoma managed with subtotal resection and 54 Gy radiation, how long should follow up MRI imaging continue, with what frequency, and for what volume?
This is an excellent question. I don't think we have clear surveillance guidelines for many primary spinal tumors, including WHO gr. 2 ependymomas like myxopapillary ependymoma. In our institution, we generally obtain total spine MRI with dedicated imaging at the tumor level q4 months in the first 2...