Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you be willing to give definitive chemo-radiation and chemotherapy to a MSI-stable T2N0 low lying rectal cancer in a young healthy patient who wants to avoid surgery?
More likely to recommend total neoadjuvant therapy hoping for induction of complete clinical response. In our hands, on average, we are able to conserve the rectum in about 55% of treated patients with excellent rectal function and a regrowth rate of less than 10%. Local excision will not address th...
Are you routinely using neoadjuvant cemiplimab for cutaneous squamous cell carcinoma of any site?
No
Do you treat the optional radcomp posterior lymph node field for patients with breast cancer?
I usually treat if medial supraclavicular node is involved, high nodal disease (10 or more) burden in the axilla, inflammatory breast cancer, or any PET avid node in the posterior triangle prior to chemo.
How do you manage dry eye related to Pluvicto Lu-177?
This is a real but uncommon side effect of Pluvicto therapy. Per VISION, it will happen in maybe 3% of patients but almost never high grade. Interestingly, the absorbed dose for the lacrimal glands is 2.1 Gy/Gbq - which over 6 cycles full dose at 7.4 GBq/200 mCi per cycle means 92 Gy. There was a me...
How do you address the axilla in an incidentally found T1bNx invasive breast cancer with extensive DCIS on bilateral prophylactic mastectomy in BRCA-2 mutated woman?
I would send her for an axillary ultrasound and biopsy any suspicious lymph nodes. Following a mastectomy, it is challenging to do a sentinel lymph node biopsy so surgical evaluation of the axilla usually requires an ALND. If by imaging the axilla is negative, I would run her tumor characteristics t...
How do you approach a patient with prostate cancer with sclerotic/lytic lesions found on a CT scan but not seen on a bone scan or PET-PSMA?
This can be a tough situation, as sometimes healthy individuals can have sclerotic or lytic foci in various bones for reasons unrelated to any type of malignancy. The first thing I would try to do is compare the CT scans to any prior imaging if possible. If these lesions are completely unchanged fro...
Would you offer partial breast irradiation for women with G2 4cm DCIS with close margins of 1mm but a very large breast size?
Although size cut off is arbitrary, DCIS tumor size is one of the risk factors for IBTR. For large-volume DCIS like this case in question, what is not known is if a 1 to 1.5 cm CTV margin would capture all microscopic areas of disease or do we need to treat larger volumes. For that reason, I favor I...
How would you approach treatment of a patient with recurrent choroid plexus papilloma with intraventricular dissemination?
The management of choroid plexus tumors starts with diversion of the CSF flow, especially in this patient with a recurrence in the 4th ventricle. A gross tumor resection (GTR) is the most significant prognostic factor, but in this patient, it might not be feasible due to the dissemination in the lef...
What is the most convenient and reproducible setup for simulation and treatment of the contralateral testis in a primary testicular lymphoma?
Frog leg position with the penis taped to the pubic/abdominal wall. Usually, electron beam with energy based on thickness and dose of 24 Gy.
Would you recommend radiation to a painful rib fracture in a patient with multiple myeloma on systemic therapy with ongoing response to treatment?
It depends if it’s a newly diagnosed MM setting versus relapsed MM setting with a rib fracture. Some possible scenarios: For the ND setting, systemic therapy with adequate pain management early on is preferred. For relapsed setting, if the rib fracture heralded the relapse then systemic therapy/pai...