Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with Waldenstrom's macroglobulinemia doing well and feeling better on ibrutinib & rituximab, but with a rising IgM, do you switch treatment or continue?
A lot depends on the pace of increase of the IgM and the line of therapy. If the pace is rapid, I would think about changing therapy. If the pace of increase is small and the patient is asymptomatic, you could continue a little longer. If planning to changing therapy, it may be reasonable to restage...
When considering post mastectomy radiation, do your recommendations change for a biopsy proven positive intramammary node in the axillary tail (prior to neoadjuvant chemotherapy) vs. positive axillary node?
Data on intramammary nodal disease suggest that it has worse outcome than node negative disease and these pts at increased risk of axillary involvement I do take that as one of adverse factors in deciding PMRT after NACT in these pts but if they have BCT done then don't change target in itself based...
How would you treat a patient with locally and distant recurrent rectal cancer who has previously received chemoradiation but now presents with pain and bleeding from the site of local recurrence?
Generally we like to see a 1 year interval between courses of radiation. We give 39Gy in 26 fx BID with a 3D conformal technique. The cumulative BED should be <100 or so. We use a 3 cm margin cranial an caudal on the GTV and include the presacral space. We give concurrent capecitabine.
How does breast cancer histology affect your decision whether to omit radiation?
More than histology grade ( grade 3) influences whether to omit RT or not .
Are connective tissue disorders a contraindication to breast radiation?
I don't have any personal experience treating Ehlers Danlos syndrome. A case report has been recently published: https://www.ncbi.nlm.nih.gov/pubmed/28727212
Do you offer consolidation thoracic radiation after atezolizumab, carboplatin, and etoposide for extensive stage small cell lung cancer?
I have not had the opportunity to treat a patient yet with carboplatin plus etoposide plus atezolizumab. This regimen is not yet FDA approved (as of 2/18/19) to treat patients with extensive stage small cell lung cancer. However, when it becomes FDA approved, I will plan on offering this regimen to ...
Are there any known issues related to radiation in the setting of vitiligo?
I have treated several breast cancer patients with vitiligo with both photon and proton radiation therapy. In Caucasian people with the disease, I have found that the areas of vitiligo either stay hypopigmented (no pigment change) or I have had a handful of patients turn bright red in the areas of h...
How would you manage simultaneous muscle invasive bladder cancer and intermediate or high risk prostate cancer in a patient who refuses surgery?
When I'm faced with a situation like this, with 2 concurrent pelvic malignancies, I like to think about how I would manage each one independent of the other and then try to design a plan that incorporates management principals of both diseases. You also have to consider how treating both concurrentl...
How do you counsel a patient on treatment with SBRT/SABR vs. thermal ablation in the setting of early stage NSCLC or lung metastases?
This is an important question that arises in tumor boards and other multidisciplinary discussions (despite what I feel is accumulating evidence that SBRT offers better control and survival). Our colleagues in interventional radiology continue to offer improved technology, and the equipment vendors s...
Would you consider nodal irradiation alone (not irradiating chest wall) in an otherwise early stage breast cancer, cN0 patient but has a positive node from a SLN bx who is status post mastectomy?
Though the presence of nodal disease is used to help identify women that benefit from adjuvant radiation treatment, patterns of failure data support that the majority of recurrences occur on the chest wall. Therefore if there are indications for nodal treatment (such as those noted above), I would p...