Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your policies/practices for physician role of SBRT/SABR treatment delivery?
Do your post-operative rectal fields differ from pre-operative fields?
You must wire and include the perineal scar. This is counterintuitive because APR is a "big surgery". But there can be surgical marginal miss and recurrences there. Often, the inguinal nodes will be at risk if the tumor was below the dentate line. Be especially careful to exclude small bowel as much...
Does the presence of DCIS in conjunction with invasive breast cancer require consideration of adjuvant RT where invasive disease alone may allow for omission?
I'm not sure there is a lot of data in the PRIME II/CALGB 9343 subset of patients looking at impact of associated DCIS in conjunction with invasive disease and its impact on recurrence with and without radiation therapy. I have not considered this an additional risk factor and have offered omission ...
What oral alternatives would you recommend as opposed to injectable GnRH agonists for those who do not wish to come to clinic due to COVID-19?
Casodex is an option. Due to liver toxicity, they would need LFTs checked before and at a future interval, effectively requiring them 3 visits to a health care facility—labs, pharmacy, labs. A single 6 month injection seems like a better proposition.
Would you offer consolidative radiation for metastatic small cell bladder cancer with good response to immunotherapy?
With the value of consolidation RT in extensive stage small cell lung cancer being questioned in immunotherapy era, I would hold off on any RT for consolidation for extra thoracic site also.
Is it reasonable to treat with RT alone for limited stage SCLC if unable to receive chemotherapy?
Yes, I think this is reasonable, though obviously expectations should be tempered, as SCLC is essentially a systemic disease and as such, RT alone should be viewed as palliative treatment or aimed at preventing imminent morbidity from local progression. I would consider a hypofractionated regimen su...
Would you consider a cisplatin-based regimen with hypofractionated radiation for bladder cancer?
Yes, with bladder only RT almost any chemo regimen is acceptable, including cisplatinum, Gemzar, or 5FU and MMC.
Is there an increased risk of pneumonitis in COVID-19+ patients receiving lung irradiation?
This is still very much an open question, since COVID-19 has not existed long enough for us to assess the full impact of the virus on radiation pneumonitis/fibrosis risk. It may be challenging to accurately determine the primary etiology of lung-related changes for COVID-positive patients who receiv...
How do you determine whether to treat a young adult with stage IA Hodgkin Lymphoma with the adult or pediatric treatment paradigm?
There is a long history of pediatric protocols for HL differing somewhat from the adult ones, but not much biologic rationale to support this, as the disease in young adults is biologically the same as in pediatric patients. Side effects of RX may of course differ, particularly with regards to RT an...
How do you balance target coverage with tolerances of the ipsilateral eye structures and the risk of vision loss in advanced head and neck cancers?
My personal approach is to always recommend induction systemic therapy for T4b unresectable disease with orbital invasion. If it is at all resectable (T4a), I agree with offering curative surgery (including enucleation) upfront or induction if that is a surgeon preference, then post-op chemoRT or RT...