Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you continue serial PSMA PET scans after 2 negative scans for patients with a persistently rising PSA post-RT?
Some context would probably be helpful for this. E.g., PSA >2 is different for a patient post-prostatectomy vs. post-radiotherapy. But, in general, if clinical suspicion of cancer recurrence/progression is high, and PSMA PET is negative, one can consider the following options: There may not be a ca...
How do you decide the right time to transition to hospice?
Talking about hospice is one of the hardest jobs we have. It's hard because we don't like doing it, because we often don't know how to do it well, and because we angst about doing it too early or too late. It's an important thing to think about. I actually think perhaps the most important factor in ...
How do you treat dermal metastases in the setting of prior breast irradiation?
There is no fixed approach. Based on effect and volume of prior RT, interval since last treatment, extent of dermal mets with or without surgical excision, and intent of care. One can do conventional fraction RT with or without hyperthermia, based on availability and gross or microscopic disease.
Should ultra-short course RT be standard for elderly or poor performance status patients with glioblastoma?
The recent phase III randomized trial published by Roa et al. examining the efficacy of short course radiotherapy in elderly and/or frail patients with newly diagnosed GBM builds upon his previous work finding equivalent outcomes in elderly patients (age > 60 years) receiving 60 Gy in 30 fractions ...
What are your top takeaways in Breast Cancer from ASTRO 2024?
There were a number of important presentations on breast cancer at the ASTRO 2024 meeting. The three randomized trial discussed below stood out.1. Abstract 1: Poppe MM, et al.: A randomized trial of hypofractionated post-mastectomy radiation therapy (PMRT) in women with breast reconstruction (RT CHA...
Does a genetic predisposition to cancer affect your recommendations regarding breast conservation and radiation?
The question posed makes the assumption that radiation should be avoided in ATM, BRCA, and p53, and asks about other genes. I would begin by stating that radiation should not necessarily be avoided in the vast majority of patients with genetic variants or mutations, even those referred to in the que...
How would you treat an elderly patient with squamous cell carcinoma of the anus who is not a chemotherapy candidate?
It's a suboptimal situation because chemotherapy improves relapse-free and colostomy-free survival, and possibly overall survival for all but the earliest stage patients. I would look into whether capecitabine alone might be an option as a radiosensitizer that might be more tolerable than mitomycin-...
When would you consider testicular RT prior to TBI for BMT?
In children with ALL treated with systemic chemotherapy alone (no transplant), the risk of testicular recurrence is ~15-20% (Br J Haematol 2003;123:396, Br J Haematol 1998;102:656). In adults with AML treated with standard chemotherapy, with or without transplant using a chemotherapy alone condition...
How do you use Boswellia for radiation necrosis?
I reached out to my colleague, naturopath Lise Alschuler, Associate Director of the University of Arizona Fellowship Program in Integrative Medicine program, for her thoughts on this question. Here is her answer:This study by Upadhyay et al. is a well-designed study which builds upon earlier studies...
Do you routinely obtain a biopsy of a presumed meningioma prior to SRS to confirm grade 1?
There is an emerging and growing body of data using various AI tools and radiomics analysis, as well as the incorporation of advanced imaging, that aim to improve the ability to predict the grade of meningioma. Most of this work remains "limited institution" in terms of applicability. In the current...