Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should immune checkpoint inhibitor be held for palliative RT to bladder in patient with metastatic urothelial carcinoma who has stable systemic disease on immunotherapy?
I assume the scenario applies to patients with good systemic disease control on immune checkpoint inhibitor (ICI) but with symptomatic primary tumor of the bladder, e.g. hematuria, pain, and obstruction. It is helpful to have a good discussion between Med Onc & Rad Onc regarding the optimal timing, ...
What are your recommendations regarding sexual activity for a couple when one of them is diagnosed with a HPV-positive oropharyngeal cancer?
We always counsel patients regarding the etiology of HPV if they have a p16+ tumor. We tell them that this is an infection most likely acquired through sexual activity and that the latency period is approximately 20 years from the time of exposure until the time of a cancer diagnosis. We note that o...
How do you create the boost fields for a definitive bladder cancer treatment?
"Map out the tumor position three dimensionally with the urologist and use all available imaging" is what they say and then after locating it/contouring it, you have to treat with a full bladder. Early in my career, I attempted this and had two issues: Localization is harder than you think. If it...
For Siewert 3 locally advanced GEJ adenocarcinoma, when do you offer preop chemoradiation (CROSS regimen) vs periop chemotherapy (MAGIC or FLOT)?
Siewert I/II GEJ adenocarcinomas are treated according to esophageal cancer algorithms, while Siewert III GEJ adenocarcinomas are treated according to gastric cancer algorithms. Consequently, perioperative chemotherapy with FLOT is the standard, evidence-based approach for fit patients with Siewert ...
When treating sialorrhea in ALS patients, what treatment schedule do you use?
I have treated one patient. We used 12 Gy in 3 fractions, delivered twice weekly. The dose was based on a systematic review that did not show a dose response above 12 Gy. Hawkey et al., PMID 26152655The 2015 study above also showed equivalency in response to therapy with 10 Gy in 2 fractions and 20 ...
Would a patient receiving intravitreal avastin have a contraindication to prostate radiation?
There may be some systemic effects but not enough for us to hold adjuvant RT.
In a patient with solitary metastasis skin/subcutaneous wrist, resected with graft, from a primary breast angiosarcoma, what would be your preferred fields and dose?
Agree, odd presentation. Hopefully, the patient was fully staged with PET and MRI brain after this was diagnosed to confirm solitary metastasis. If so, agree with chemo first; angiosarcoma in general, has formidable DM risk (though hard to know how much that applies to this presentation) so makes se...
Would you consider upfront immunotherapy in a patient with MSI strongly positive locally advanced adenocarcinoma of the anus versus standard of care?
Great question. For anal and rectal cancers, histology generally supersedes location in determining treatment paradigm, so an anal adenocarcinoma would be treated like a rectal adenocarcinoma (you might consider anal canal involvement T4 staging).Standards of care for MSI-H locally advanced rectal a...
In light of the recent MSKCC Phase 2 data indicating reduced skeletal events with treatment, how will you approach management of patients with asymptomatic bone mets?
It sounds promising, but there is not enough information about the cohort for me to make an informed assessment. One problem I have is that bone metastases from different primary malignancies really shouldn't be grouped together. It's a good starting point for more investigation, and I look forward ...
Would you offer palliative re-irradiation to the sacrum for a patient with a prior history of RT for rectal cancer?
Local recurrence of rectal cancer is still a quite common situation we see in the clinic. Presacral space lesion with sacral involvement is one of the most common scenarios. As a tertiary center, we have quite a few cases with locally recurrent rectal cancer. All these patients are evaluated by a mu...