Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider head and neck RT for a patient with pre-existing carotid blowout due to tumor involvement?
Yes. Tumor or treatment. Roll the dice. You know the outcome if you don’t. That said, I don’t recall confronting this in over 40 years. If due to tumor, I suspect that they didn’t make it to me.
In light of the recently published OPRA trial, could one consider organ preservation as a standard treatment option for appropriately selected patients treated with total neoadjuvant therapy for locally advanced rectal cancer?
I think that it is NOT appropriate to consider watch and wait as a standard therapy. The OPRA trial did not test that concept- they just showed that they get pretty good results at 3 years using this technique when compared to historical data. They have not done any type of randomized comparison dem...
How long do you wait following spinal surgery to administer SRS?
The answer depends. If separation surgery was performed, I would start sooner than later and be aware of skin dose and minimize as much as possible. Superficial dehiscence shouldn’t become problematic after SRS given minimal skin dose (if planned accordingly). If a large amount of tumor was resected...
How long do you delay post-op radiation for cord compression if there is superficial proximal scar dehiscence?
In the 2005 Patchell trial that established decompressive surgery followed by RT as the standard of care, patients started radiation within 14 days after surgery. If the skin wound isn't closed by then, don't wait around. I would get started anyway and try to treat around it with oblique beams, or u...
Is your decision to hypofractionate or boost altered by surgeon's plans for DIEP reconstruction after radiotherapy?
I would not offer pre-operative RT off trial at this time. If planning for lumpectomy, I would use my standard consideration (moderate hypofractionation standard, can consider 5 fx WBI for appropriately selected) and boost factors (age < 50, ER-, margins). It's unclear the rationale for a DIEP post ...
Would you treat the entire bladder to an elective dose for definitive radiation of a urethral cancer?
Not necessarily. Usually treat the entire urethra with the inclusion of bladder neck if cancer is in the proximal urethra.
Is it safe to give large fraction stereotactic irradiation for brain metastases concurrently with VEGF inhibitors?
In a patient who has poor pulmonary function test results, do you treat esophageal cancer with concurrent chemoradiation therapy?
Yes, preferably with protons.
For a refractory GI bleed, would you ever consider re-irradiation of an unresectable gastric or GEJ tumor in a patient previously treated with definitive chemo-RT?
We do this occasionally, with good success and no major complications of which I’m aware. This is likely due to 3 factors: 1) There has been substantial repair after the first course. Our crude rule of thumb is 50% repair after one year. We very rarely re-irradiate before this. 2) Low dose to provid...
How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?
In my experience, tumor boards serve 2 purposes. Firstly, they are designed to bring multiple specialists and cancer providers together in real-time to facilitate patient care. Secondly, they help educate the various disciplines based on a robust interaction. Virtual conferences are complicated by d...