Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat your left sided breast cancer patients with DIBH (deep inspiration breath hold) and IMRT when the target includes regional lymph nodes?
We do treat with tangential beam RT where match between tangent and supraclav is Same half beam block with no issue with matching
Would you offer prostate specific PET imaging (e.g. Axumin or PSMA PET) in a post-RT prostate cancer patient that has a rising PSA that has not yet met failure criteria?
Maitre et al., PMID 35189154 This study shows a high pick up rate with PSA not meeting failure criteria and many of them had focal relapses which are potentially salvageable.
Are you routinely offering spine separation surgery followed by SBRT/SRS for spine oligometastatic lesions abutting the cord?
I do not offer separation surgery. I view it as an extension of decompressive surgery by surgically creating a gap that may allow the radiosurgery to the epidural lesion. It sounds good but, in fact, this adds a significant surgical invasiveness with anesthesia in order to perform the non-invasive r...
Have the presented results of GOG 249 at ASTRO 2017 changed management of early stage uterine papillary serous cancers from chemo +VC/EBRT to pelvic RT only?
UPSC tend to fail with distant mets. Therefore chemotherapy is reasonable. Per the study results Chemo + VC/EBRT is reasonable. At times chemo is not feasible/ tolerated so we use EBRT+ Vc. I have enrolled pts on this study and noted the interesting results.
For patients with a history of seizures secondary to brain metastases, what are your criteria for discontinuing antiepileptic medications if the seizures have been controlled since SRS or surgery?
Brain metastases patients are discussed at our multidisciplinary brain metastases tumor board whether they have received SRS, surgery or WBRT. In general, I like to keep antiepileptics for up to three months in patients who have seizures that are controlled. Factors that I consider for discontinuing...
Do you treat the ipsilateral neck and primary site for a resected skin cancer with parotid mets?
Yes, assuming primary site from skin was resected within 2-3 yrs of the parotid met presentation AND, it is in close proximity to the parotid - that it could be addressed using a small electron field matched with the parotid fields. In that case, I would include the original skin site together with ...
What is the appropriate follow up after chemoradiotherapy for patients with anal SCC?
A few points of note. First, the evaluation of the primary site is usually better done by a physical exam than by any imaging study. Therefore, a careful rectal/anal exam is essential at each follow-up. I will usually observe residual abnormalities in the canal as long as it is regressing and there ...
How do you manage adult brainstem lesions in the absence of a tissue diagnosis?
I would: Discuss with the neuro-radiologist and obtain another imaging study(e.g. PET or MR perfusion) that could support the MRI diagnosis of high grade glioma. Have a thorough discussion at a multi-disciplinary neuro-oncology tumor board to make sure surgical biopsy is unsafe and there is consens...
What post-treatment imaging do you recommend for glomus jugulare tumors (paragangliomas) following definitive radiation therapy?
MRI or CT 6-12 months post-RT assessing for stability in tumor size or possible tumor regression. MRI will help show a reduction in flow voids, decreased heterogeneous enhancement, and a reduced T2 signal. Studies have demonstrated tumor regression in 57% to 73% of patients followed by CT as well [S...
Do you routinely recommend patients with spine metastases wear neck collars or back braces?
The neurosurgeons here do not believe that collar and brace for metastasis should be applied routinely, even inpatients with pathological fractures. The issue with these collars and braces is that it makes the musculature weak and often times they develop worsening pain and instability because of it...