Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach an AVL (atypical vascular lesion) of the breast?
I would favor excision (presuming post EBRT) as there is some suggestion that they can transform to angiosarcoma.
What is your recommended dose and treatment volume for multifocal glioblastoma involving the bilateral cerebral hemispheres?
Median survival of multifocal/multicentric GBM is only about 5-10 months across series, and a recent study reported 2-year survival only 4% (PMID:22920963). Optimal radiation dose will depend on performance status, neurologic status, comorbidities, age, and social situation. Reasonable doses are:- 0...
In a medically inoperable, elderly, frail patient with muscle invasive, node negative bladder cancer, would you consider combining immunotherapy with radiotherapy instead of chemotherapy?
Maybe but what about using low dose Gemcitabine ( 27mg/M2 twice weekly) with daily XRT as in NEG 0712? This seems much better to me! WS
How do you manage adjuvant hormonal therapy in a patient with high risk prostate cancer who already received prolonged neoadjuvant ADT prior to being referred for radiation?
For the purpose of answering this question, I will assume that the patient has a stable or declining PSA and has not shown signs of castrate resistance. In general, I am more concerned with the response to ADT prior to beginning radiation, rather than the duration of ADT before RT. Retrospective dat...
How do you approach local control in intermediate risk bladder rhabdomyosarcoma in very young (<24 months) children ?
These two approaches are probably equivalent in qualified hands (cystectomy / prostatectomy or definitive RT) in terms of local control. This issue is balancing morbidity. The surgical approach in many cases will require a full cystectomy, necessitating the creation of a neobladder or some other re...
How would you manage a patient with a very large adenocarcinoma of the rectum (10 cm) that extends to the anal verge with positive peri-rectal and inguinal lymph nodes, but no distant organ involvement?
Anyone with locoregionally confined rectal cancer that is medically operable should be considered for definitive surgery after neoadjuvant chemoradiation without any question. The survival of node positive rectal cancer based on historical data when the chemotherapy was not as active as today was 50...
How soon after completing radiation should anti-estrogen medication start?
I do not have a strong preference. For some high risk patients, the oncologist is eager to start, even during radiation. For a standard risk patient, waiting until following the peak reaction is my usual recommendation (~1-2 weeks post RT). This is to avoid the potential for the patient to have both...
Is ALND required in all patient with clinically positive axillary nodes?
The role of surgical management of the axilla is clearly an area that is evolving, especially in light of effective systemic therapies for breast cancer and the lack of convincing evidence of a survival benefit. The potential functional morbidity associated with an axillary dissection is not small s...
Is there a role for prophylactic cranial irradiation in patients with NSCLC?
The question of PCI for stage III NSCLC has now been asked twice in the modern era. The abstracts of both of these studies are below. They both show that although PCI reduces the incidence of brain metastasis, it does not improve survival. And when there is the fatigue and neurotoxicity associated w...
How would you advise a woman who had a full axillary lymph node dissection on the risk of lymphedema with mountain climbing?
Well, this is obviously a question with no evidence based answer. Overal, the risk of lymphedema after axillary LN dissection is around 20-25%. Most likely these patients will receive regional LN radiation (due to positive LN's) and the risk will increase to 25-30% (Warren et al). Other risk factors...