Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend surveillance for secondary malignancies of the rectum and bladder after prostate XRT?
I think it's important to be sure that patients are up to date with screening for colorectal cancer before beginning a course of prostate XRT. I have had an occasional patient who was found to have a colorectal cancer on colonoscopy performed pre-treatment because they were out of compliance with sc...
How would you manage the axilla of a patient with a recurrent ipsilateral breast cancer treated with lumpectomy, sentinel node biopsy, and IORT?
Generally, I am unenthusiastic about reirradiation of breast cancer patients who've been treated with BCT. Even if one can avoid critical structures such as heart and lungs, brachial plexus, etc. Cosmesis is likely to be compromised, given sufficient length of follow-up. In this instance, presumably...
Does Oncotype score affect your decision to do regional nodal irradiation in a patient with early-stage breast cancer?
For ITC, would not change based on genomic testing and treat like node negative disease.
Do you consider the duration of lung/lobar atelectasis in your decision making while offering airway stents for malignant central airway obstruction?
Yes, always. We review old imaging to determine when there is a post obstructive pneumonia or collapsed lobe/lung secondary to endobronchial obstruction (extrinsic or intrinsic). The old teaching was that, if a lobe is down for more than two months, it is unlikely to be salvaged, even after the endo...
Would you consider SBRT for a patient with a solitary HCC lesion, with SLE/lupus previously on immunosuppression?
This one is a little bit tough, because there are other treatments for a solitary HCC lesion (surgery, TACE, RFA...), it may be better to use those options and avoid the risk of potentially enhanced toxicity. However, I suspect the risk is not very large as the risk from SBRT to the liver is so smal...
Do you cover the sacral foramen when treating pelvic lymph nodes for prostate cancer?
I don’t cover the sacral foramen when treating the presacral nodal region for prostate or gynecological cancer - this reduces the dose to the sacrum and thus risk of insufficiency fracture. However, I do try to cover the foramen for locally advanced rectal cancer, especially with posterior mesorect...
What is your recommended management for a pT1N0 perianal moderately differentiated SCC s/p wide local excision with close 1 mm deep margin?
It’s important to examine the patient before proceeding. Anal and peri-anal cancer can be multi-centric. I have had cases with pathology reports like this who had other areas of clearly invasive disease remaining. Assuming staging studies are negative and the physical examination reveals only a hea...
How does the performance of a LYMPHA procedure affect the timing and planning of post-mastectomy radiation?
This is increasingly being seen for patients undergoing ALND with LYMPHA or LVB procedures. They often have their arm wrapped for several weeks post-op. I will try to simulate 4-6 weeks postop; prior to sim, my nurse will reach out and if the arm is still wrapped or limited ability to lift the arm, ...
Do you ever consider hypo-fractionated palliative radiation postoperatively for bone metastases?
Yes, we use it routinely. We consider it one of the wise choices.
For a stable AVM after SRS, would you consider repeat SRS?
Yes. 3 years.