Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role for adjuvant monoclonal antibody therapy with radiation for diffuse intrinsic pontine glioma?
There are several publications showing a small synergy when combining RT with immunotherapies—thought to be effective largely by the induction of a pro-inflammatory response.There are actually several different aspects to note for use of mAbs in the brain. The biggest argument you'll hear is likely ...
Would you recommend prophylactic cranial irradiation (PCI) for a teenager with a T cell acute lymphoblastic leukemia in remission?
No—modern systemic and CNS directed therapy is sufficient to mitigate the historic higher risk of CNS relapse (Vora et al., JCO 2016). While there is still a small risk of cranial relapse with modern systemic therapy, the improved success of response and risk adapted strategies utilizing varying deg...
How would you manage a treatment interruption during SBRT to the liver?
The answer to this question is "it depends". Given that the original delivery of SBRT was two fractions per week over a period of 2.5-3 weeks for 3-5 fractions, if the patient completes SBRT within this time frame, it would still not truly qualify as a treatment interruption.Further, if you deliver ...
Do you adjust PSA for finasteride use when determining prostate cancer stage and risk category?
We generally use the rule of 50% (real PSA is twice the lab value when on Finasteride).
Do you offer radiation therapy for locally advanced, node positive rectal adenocarcinoma in patients with Li-Fraumeni syndrome?
The only thing that is clear is that patients with LFS have an increased risk of secondary malignancies secondary to ionizing radiation. The risk is as high or higher than the absolute risk reduction of local tumor recurrence. For this reason, elective radiation is a relative contradiction. In LARC,...
What margins do you use for hypofractionated treatment of glioblastoma?
Since I am generally using hypofractionated treatment in elderly, unresectable, or poor performance status patients, I tend to favor smaller margins to minimize the risk of toxicity. The largest I would use is edema +1cm for a small tumor with minimal edema. For a large tumor with extensive edema, I...
Will you be recommending relugolix due to rapid suppression of testosterone and lower risk of cardiovascular events?
We still have the option of monthly degarelix if one is looking for a GnRH antagonist.
In a patient who had childhood sarcoma treated with surgery and chemotherapy but without radiation, would this history impact their risk of second malignancy from radiation to a new cancer given as an adult?
Absolutely. Recent data from SJLIFE suggests that the cumulative incidence of developing any subsequent cancer can still be high among patients treated without radiotherapy, if the patient is a carrier for known mutations characterized by a well established monogenic cancer risk with high-low penetr...
When sending patients for follow up chest CT's after SBRT or chemoRT, how do you determine whether to send for scans with or without IV contrast?
My rule for lung SBRT has been to minimize the use of contrast given the patient population we are treating (elderly, frail, and a desire to minimize kidney stressors), and the fact that we are following lung parenchymal lesions which are generally well visualized without contrast. I also have never...
Would you give full post-operative dose radiation for an undifferentiated high grade pleomorphic sarcoma of the extremity with close surgical margins if the patient had previously received <20Gy preoperatively?
The following response was drafted together with @Dr. First Last:We would offer post-operative RT to 50 Gy via shrinking field technique, delivering 34 Gy to a CTV1 similar to that given pre-operatively (as described below, because of the pre-operative RT, the post-operative CTV1 does not need to in...