Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer consolidation chemotherapy prior to durvalumab in locally advanced, unresectable NSCLC?
I do not offer consolidation chemotherapy to patients prior to durvalumab in patients with locally advanced, unresectable NSCLC. The PACIFIC trial was a randomized phase III trial that established the role of consolidation durvalumab after definitive chemoradiation for patients with stage III NSCLC....
How would you manage treatment of keloid that is so large it requests a graft?
16 Gy/4 fractions
Does postoperative radiation within 24 hours of a skin graft with a keloid resection increase the risk of graft failure?
The amount of radiation required to prevent keloid recurrence after excision is lower than what would be expected to compromise a skin graft. The studies cited are dealing with postoperative radiotherapy for cancer, where radiation doses are required to be higher than what is used for a keloid, and ...
Is there anything you use for patients with anticipatory nausea who has failed Ativan and Zyprexa?
I know of no data, but I would consider hypnosis, mediation and mindfulness, cognitive behavioral therapy, acupuncture, and medical marijuana as possible options for anticipatory nausea refractory to lorezapam and Zyprexa. Hypnosis, mindfulness, and cognitive behavioral therapy are in a sense are re...
How does positive peritoneal washings factor into your treatment decisions regarding pelvic radiation and/or chemotherapy?
At this point, for patients who lack other adverse factors, we do not change management based on positive cytology for endometrioid histology.
When in the treatment of OA do you think it is optimal to offer LDRT?
Evidence reality check: Two well-conducted sham-controlled RCTs (hand and knee OA) were negative for clinically meaningful benefit at their primary endpoints. (Minten et al., PMID 30231990, Mahler et al., PMID 30366945). ArthroRad (multicenter randomized, single-blinded) compared standard-dose vs ve...
What is your preferred treatment for non-contiguous Stage IIA Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL)?
Prognosis of patients with early stage NLP-HL is excellent with any treatment, and multi-institutional studies have shown 5-year survival rates of 98% (Michael S. et al. Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG. Blood 2020; 13...
Should hydroxychloroquine be stopped prior to standard or hypofractionated breast treatment?
We don’t stop hydroxychloroquine for RT.
What is the appropriate role for radiation therapy in patients with HCC or intrahepatic cholangiocarcinoma who are transplant candidates?
Most HCC and cholangiocarcinoma patients who are transplant candidates are often also SBRT candidates. We have used SBRT to bridge patients to transplant. These patients often have had prior liver directed therapies such as MWA, RFA or TACE. There are no randomized trials comparing different liver d...
Would you use adjuvant hypofractionation (15-20 fractions) after BCT with negative margins for a patient with malignant phyllodes tumor?
We conventionally fractionate all our phyllodes patients given there is really no data currently (that I’m aware of) that supports hypofractionating this uncommon disease entity.The Dartmouth-led series studied patients using conventionally fractionated radiation.Barth Jr. et al. PMID 19424757Their ...