Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend sperm banking for males prior to undergoing radiation?
To the first question in the prompt, I would recommend sperm banking for any patient who was receiving a sufficiently high radiation dose to the testes and desired fertility preservation. In my practice, this are few patients, although it is an important consideration for younger patients. To the se...
How would you approach new dermal mets in a patient who recently finished chemoradiation for head and neck SCC?
Dermal mets are M1 disease. Since the patient received chemo, (s)he has a medical oncologist who should manage the case moving forward.
Would you offer XRT as bridging for all patients with limited pre CAR-T disease or as consolidation for only those with residual PET-avidity on day+30 post CAR-T?
There are no studies comparing these 2 approaches. However, given the detrimental outcomes of post CAR-T relapses, I would consider maximizing peri-CAR-T treatments as much as possible as long as the toxicity profile is reasonable, and would not view these 2 approaches as mutually exclusive. I would...
Do you modify the external beam plan that follows if a patient develops prolonged urinary retention after LDR?
This situation is one of the reasons that I prefer to sequence LDR brachytherapy after external beam radiation. In a patient who develops urinary retention following upfront LDR brachytherapy, I would delay external beam until they are able to void spontaneously if at all possible. This could take w...
How would you treat high risk prostate cancer in a patient with autonomic bladder dysfunction?
Personally, I have not treated a large number of such patients, but they've generally had this problem due to diabetes or Parkinson's disease. However, it might be prudent to wait for the workup for an etiology before starting radiation therapy. For high risk patients, you're generally considering a...
What do you do when the dose constraints for heart and/or lung do not pass at all in a whole breast treatment planning?
Clinical radiation pneumonitis is rare. For example, a recent study of 191 patients treated with hypofractionation at the University of Pittsburgh found symptomatic pneumonitis in only one patient (Schad et al., PMID 36332799). Another recent study from South Korea of 1,847 patients in which 79% of ...
How do you approach patients with node positive sebaceous cell carcinoma of the eyelid for adjuvant chemotherapy and radiation?
Postop RT. I don’t know of data supporting adjuvant chemo.
For patients undergoing TNT for rectal cancer with planned operative management, what is the optimal sequencing and timing of workup imaging and procedures?
I think the question that is posed does not really make sense as written. One should not be making decisions about management (i.e. TNT) before the staging evaluation is complete. If a patient presents with a newly diagnosed rectal cancer, the first thing to do is to stage to find out whether the pr...
When do you offer SBRT for a small, slowly growing lung lesion?
I caution ALL radiation oncologists from pulling the trigger on a case like this in a vacuum. Why did I use the word "caution"? It's because we recently studied how often a radiation oncology program is comfortable delivering SBRT w/o histopathological confirmation, and the range was between 0 - 61%...
If a patient is noted to have multiple PIRADS-4 and PIRAD-5 lesions of the prostate on MRI, do you offer simultaneous integrated boost via FLAME?
It is a reasonable approach to boost multiple lesions. The FLAME protocol allowed for the treatment of multiple GTVs as long as dose constraints could be maintained. These investigators published a separate paper evaluating the contouring on the trial and reported a maximum of 5 lesions boosted in a...