Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer SBRT to an oligometastatic non-vertebral bony site that already has a pathologic fracture?
If it’s a rib or non-long bone lesion (as they won’t severely impair limb function), SBRT can still be a treatment option. If there is good tumor response, remineralization may occur. For long bones, open reduction + internal fixation have to occur first as in all likelihood, there’s limb deformity ...
For what OPX subsites would you consider NOT treating the high retropx drainage in the node positive neck?
None
How do you approach ADT in a post-prostatectomy patient who had higher Gleason score on biopsy but a lower Gleason score on final pathology?
I would only base my decision on the pathology of the final prostatectomy specimen, and ignore the prior biopsies.
How would you treat a patient with metastatic cancer with a lesion invading the small bowel causing bleeding and potential obstruction?
Radiation reliably relieves bleeding but typically does not relieve obstruction. It may be worth trying if there is not an impending obstruction. We have plenty of experience in rectal cancer that this is a successful strategy. Since it's located in the small bowel, I would use standard fractionatio...
Would you ever consider focal brachytherapy treatment in a patient who have in-prostate recurrences after RT?
Yes, our preference is focal treatment for unilateral disease on imaging (PSMA, PET, and MRI) and concordant biopsies. Our data suggest that this is just as effective as whole gland treatment for recurrences with possibly less toxicity. For patients b/l recurrent involvement after prior radiation tr...
What do you quote as the recurrence risk without radiation for patients that undergo neoadjuvant systemic therapy followed by lumpectomy and are found to have a complete pathologic response?
We don’t have any data to quote and this is still an unanswered question. Rather, there is an interesting phase 2 study omitting surgery in these, it’s showing excellent outcomes.Kuerer et al., PMID 36306810
Is there any role for RT in the management of florid LCIS after mastectomy?
No role of radiation therapy in this case.
How would you manage a patient who received pelvic radiation 15 years ago and now has a 5 cm colon adenocarcinoma and squamous cell carcinoma of the anorectum?
I think the objective in a retreatment case like this is to maximize the chances of curing cancer with as little RT as possible. I would consider disease free survival with a functioning colostomy a better outcome than survival with an intact rectum but chronic difficult-to-manage complications. I w...
Do your radiation treatment recommendations change if a breast cancer patient does not complete a full course of neoadjuvant chemotherapy?
No. For the usual patient who has operable/resectable breast cancer, who is planned to have induction chemo followed by surgery, failure to complete the induction chemo would not alter my planned RT. Inherent to this question is the related question of: "Should we alter the RT plans based on the res...
Do you recommend adjuvant radiation for a recurrent pT1bN0 vulvar carcinoma?
For recurrence disease, if the depth of invasion is more than 1 mm and nodal assessment is not done then would favor/discuss RT. Data shows with each recurrence, risk of nodal involvement (15%) goes up which is hard to salvage Grootenhuis et al., PMID 26428940.