Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the best treatment for pT2 cN1 seminoma with mild elevation of B-HCG (~100)?
I would recommend making sure that the pathology is seminoma (with either review of the orchiectomy specimen and making sure there are trophoblastic elements or a biopsy of the retroperitoneal lymph node) as the beta hCG level is getting close to the upper end of what I would expect from a seminoma....
Is it safe to give radiation to a breast cancer patient with discoid lupus?
In published data with whole breast, it is well tolerated and we don’t consider this as a contraindication to BCT.
After definitive prostate RT, when do you prescribe ADT for local salvage (EBRT, HDR, LDR)?
For patients with localized recurrence after definitive radiotherapy, re-irradiation without ADT is a reasonable course of action and the one I usually favor. There are no current clinical trials that have been reported to demonstrate the benefit of ADT in this setting, but this practice is consiste...
What is your treatment approach for a recurrent brainstem glioma?
Recurrent brainstem glioma is a very challenging situation. One could consider participating in a clinical trial if available, especially one that targets some of the known mutations in the tumor (such as histone h3, TP53, ATRX, ACVR1, and others). We have previously re-irradiated a few patients at ...
Would you omit pelvic XRT in a high risk prostate patient with negative nodal uptake on PSMA but has risk of nodal involvement >15% by nomogram?
Based on POP-RT, if they are a high-risk group, I would add pelvic RT.
How do you manage triple negative primary squamous cell carcinoma of the breast?
Rare disease with no defined SOC but limited literature suggest poor outcomes as they don’t respond to systemic treatment like TNBC.Hennessy et al., PMID 16258085
Would you consider post-operative SBRT following long bone stabilization (i.e. femoral intramedullary nail) for radioresistant tumors?
It depends on the type of surgery done. Using proximal femur as an example, if an IM or interlocking nail is done, the nail passes straight through the tumor and contaminates the whole medullary cavity. The CTV will need to include the tumor plus the femur down to the femoral condyles. SBRT won’t be...
What dose and fractionation do you recommend for an unresectable epithelioid hemangioendothelioma of the rib?
Conventionally fractionated radiotherapy [60 Gy in 30 fx] has been described for this very rare clinical scenario, i.e., primary unresectable disease. This reference provides a good review of this disease entity and its management [Stacchiotti et al., PMID 34090171]. As a function of tumor location ...
How would you manage an adult patient status post subtotal resection of spinal osteoblastoma?
US can be helpful if performed serially. If/when there is evidence of growth, discuss ablation options with IR if feasible.
How would you manage young female patients with a phyllodes tumor of the breast s/p excision with a positive margin at the posterior fascia?
I would still favor excision if possible and observe if benign phyllodes. If borderline or malignant, consider adjuvant RT.