Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When would you recommend standard of care over hypofractionated treatment in an elderly patient diagnosed with Glioblastoma?
Treatment of patients with newly diagnosed GBM who are >70 years of age is controversial and treatment decisions should be individualized. Some patients who are GREATER THAN 70 years of age are candidates for standard 6-week RT+TMZ and some patients who are LESS THAN 70 years of age may require modi...
How do you discuss curative vs palliative treatment intent for patients with favorable risk 1p/19q co-deleted oligodendrogliomas?
Although my name is on a publication calling low-grade oligodendroglioma an "incurable disease", this is not a term that I use with patients — even in the case of glioblastoma. We do not have a published 20-year follow-up of RTOG 9802 to see if there is a plateau in PFS. Are we only delaying inevita...
How would you approach radiation for a patient with limited stage small cell lung cancer who refuses chemotherapy?
As the standard of care is systemic therapy for all that are medically fit, I’d spend time probing reasons, or the legitimate fears and concerns trying to change their mind. If limited disease, I would discuss the reasoning for local therapy, start with the standard (45 Gy/BID/3wks) and consider the...
How do you manage unresectable granular cell tumors of the orbit?
Try RT. Unresectable is unresectable.
Do you measure testosterone in men who will be receiving ADT?
I do check before starting ADT. I make sure to check after ADT completion as well. A post-treatment low PSA level in the setting of a low testosterone has a different meaning than a low PSA in the setting of a recovered testosterone. It also gives you a potential explanation for a slight temporary P...
How would you approach a morbidly obese patient with early stage favorable breast cancer who is premenopausal?
Yes, if favorable phenotype, would do APBI.
What is the most efficient way to contour small and large bowel?
MIM has a very user friendly and I like airplane mode. In general, it can be sometimes difficult to determine small from large bowel but if there is air, it is usually a sign that it is large bowel and if it is only liquid, usually small bowel. The terminal ileum sometimes has air in it, and the col...
How would you treat a patient who is HIV+ with a p16+ SCC obturator node presumed to be T0N1 anal cancer?
Patients with SCCa unknown primary met to pelvic nodes are highly curable. We published 60% 5Y survival. You almost never find a primary, one almost never presents later without elective treatment. If it does, it is easy to salvage with radiation or surgery. Therefore, I do not recommend elective tr...
When would you consider a workup for C. diff in a patient with diarrhea under-going concurrent chemoradiotherapy for rectal cancer?
Good question – and hard to pinpoint a strict answer. I think any time the diarrhea is out of proportion to expectation (i.e., very early in RT course), clinically significant (dehydration, etc), and not controlled or responding to anti-diarrheal medications, especially in the setting of C. diff ris...
Would the presence of a close but negative pleomorphic LCIS surgical margin impact your decision for APBI in a patient who is otherwise a favorable candidate?
There are evolving data and ideas around pleomorphic LCIS with some consideration of treating it like DCIS (Savage et al., PMID 29894223; Desai et al., PMID 29947004).As such, I would consider this margin similar to a close DCIS margin. If there is invasive disease with this, I am fine with no tumor...