Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you hold ADT prior to biopsy of possible prostate cancer metastatic disease?
ADT can affect the ability to assign a Gleason score, but I am assuming this is not an issue here. We biopsy new sites of metastatic disease in people on ADT all the time to confirm progression and to get tissue to identify potentially actionable targets. The only time I would deliberately hold ADT ...
In what situations, if any, is it appropriate to forego surgery for nodal recurrence (intraparotid and/or ipsilateral neck) of cutaneous SCC and definitively treat with chemo-RT?
I would consider definitive chemoradiation therapy if a patient was medically inoperable or the cancer was surgically unresectable. Otherwise, I would advocate for therapeutic lymphadenectomy, and usually, adjuvant radiotherapy, unless the pathologically evaluated nodal disease was low risk (only on...
How would you approach a young patient with stage I follicular lymphoma of the mesenteric lymph nodes?
This is an excellent question that is often discussed in guideline panel meetings- with a fair amount of disagreement among parties. As radiation therapy leads to long-term disease control in ~50% of patients with stage I FL (and is not cured with either chemotherapy or immunotherapy), my preference...
Would you recommend the addition of radiation to neoadjuvant chemotherapy in unresectable cT4b sigmoid adenocarcinoma (at or above the peritoneal reflection) adherent to the bladder?
Yes. It’s unresectable in the pelvis. This is not an uncommon scenario. I haven’t found it any more problematic than treating a rectal cancer invading the bladder.
How do you approach a breast cancer with noninflammatory skin invasion (T4b)?
For a T4b breast cancer with limited skin involvement, BCT is an option. For adjuvant RT, I would consider bolus around the involved region for part of treatment. Bolus decision can be made based on final pathology and response to NACT (if treated with that approach). If the patient undergoes mastec...
When would you hold anticoagulation medications in patients undergoing a tandem and ovoid/ring?
We usually don’t hold unless planned for hybrid with needle placement. We would make sure sonogram is available for placement of tandem to avoid false track.
How would you approach residual ipsilateral diaphragmatic disease for M1a thymic cancer after induction chemotherapy and otherwise complete resection of primary and pleural disease?
I would favor surgical approach to resect it if the patient can tolerate it. RT could be considered but motion management is crucial. The data on second-line chemo is very limited.
Would you consider SBRT for node negative small cell carcinoma of the prostate?
There are no prospective data to guide the use of RT in the management of small cell carcinoma of the prostate. Retrospective data would suggest possible benefit at least in terms of control of disease in the prostate with the addition of local RT to systemic chemotherapy (see Oke et al., PMID 33824...
Do you consider clinically node negative patients who have been on neoadjuvant endocrine therapy eligible for omission of axillary dissection if their sentinel node is positive?
No good data and we have proceeded with regional nodal RT instead of ALND in these patients who are imaging negative and post endocrine SNLN node positive disease.
Would you offer RT for a nodal recurrence of NSCLC that has resolved radiographically after chemotherapy?
Nodal recurrences are bad. When addressing nodal disease that "disappears" after chemotherapy, I have modeled my decision making on the premise used in small cell lung cancer treatment where even in the face of CRs on imaging after chemotherapy, radiotherapy was always added to the mediastinal (noda...