Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does the presence of interstitial cystitis disease affect your decision to offer post prostatectomy salvage radiation therapy?
The existence of pre-existing interstitial cystitis does not change my recommendations for 1) the need for salvage RT, or 2) the dose/volume. Certainly this man would not be ideal for adjuvant post-operative RT, but with the results of RADICALS and RAVES, adjuvant post-operative RT should be offered...
Following mastectomy with a SNB and single positive axillary lymph node, would you refer a patient back for an axillary dissection if she has borderline indications for PMRT?
For macromets: If there is no indication for PMRT, then patients are referred back for ALND. That being said, there are patients who decline ALND because of lymphedema and in these patients do perform PMRT with RNI in lieu of ALND . For micromets: No additional axillary intervention and no addition...
Do you offer concomitant chemotherapy and radiation to patients with locally advanced ulcerated breast masses that have good performance status and are potentially curable?
I tend to evaluate these on a case by case basis: 1. Locally advanced, potential for surgery but not resectable currently, already received some systemic therapy- Consider chemoradiation usually with xeloda 2. Locally advanced, limited/no potential for surgery- usually go with chemo first and if no ...
Would you offer SBRT to small but growing level II lymph nodes in a Kadish D, multiply recurrent multifocal esthesioneuroblastoma?
In a multiply recurrent esthesioneuroblastoma with multi-focal disease, I would NOT offer SBRT to the primary treatment, but rather comprehensive neck nodal fractionated RT, assuming that there has not been prior RT; if there was prior RT, I would still attempt to perform a multi-RT platform compara...
Can total neoadjuvant therapy be considered an option equivalent to standard of care treatment for patients with T3N0 or T3N1 rectal adenocarcinoma?
NCCN says that it is a standard of care for this group of patients (excluding early T3N0 without threatened mesorectal fascia). Theoretically, TNT should be better tolerated, allow patients to complete all of the chemotherapy, able to improve organ preservation rates, and improve oncologic outcomes....
Is the presence of STUMP (Stromal tumor of Uncertain Malignant Potential) after prostatectomy an indication for adjuvant radiation?
Based on limited data there is no role of adjuvant RT for STOMP
Do you recommend neoadjuvant radiation or chemoradiation for patients with T1-2 N0 adenocarcinoma of the anal canal prior to APR?
For the most part, anal adenocarcinoma is treated like rectal adenocarcinoma. Therefore, as the question is written, i.e. the patient will be getting an APR, I don't think there is enough data of a benefit for treating a T1-2 N0 adenocarcinoma with chemoradiation to justify the toxicity. However, i...
What chemotherapy regimen do you recommend with radiation therapy for cervical esophageal squamous cell carcinoma?
I would use weekly carboplatin/paclitaxel in this setting. Fluoropyrimidine + platinum is reasonable but will likely be more toxic, and I'm not aware of any data indicating that it's a more effective regimen.
How would you manage a recurrent mediastinal node 2 years after 45Gy BID to this region with combined chemotherapy for SCLC in patient no longer tolerating systemic therapy?
If comprehensive restaging (PET, Chest CT with IV contrast, brain MRI) demonstrated a single biopsy proven nodal recurrence 2 years after standard chemo-XRT, I would retreat the patient. The critical structures are likely to be the trachea (tolerance dose ~90Gy) and the esophagus. There has been som...
For patients with p16+ SCC of a cervical lymph node subsequently found to have an oropharyngeal mass on imaging, is it necessary to biopsy the primary site prior to proceeding with definitive RT?
No. When it gallops like a horse, there's no need to think of a zebra - unless you're in wild Africa. And if the patient had presented with biopsy-proven p16+ neck node metastatic SqCC with "unknown primary" while a PET/CT showed suspicious uptake at the oropharynx, one should treat the presumed pri...