Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage a hemorrhage from a cavernous malformation following SRS?
As the evidence for benefit or irradiating AOVMs is circumstantial at best, I am referred quite a few. Bleeding after treatment would be managed on a case-by-case basis but would often be expectant and would not be influenced by the prior SRS. I would personally not re-treat an AOVM — especially the...
Would you recommend consolidative RT for an HIV-positive patient with Stage I bulky DLBCL of the mediastinum s/p R-EPOCH?
The simple answer is that for most bulky limited-stage DLBCLs, I would favor consolidation ISRT (Preferred per UpToDate and +/- per NCCN). Some support for consolidation RT for bulky DLBCL after modern regimens incorporating rituximab comes from the following: A comparison of patients not receiving ...
In a patient with a pT3N0 rectal adenocarcinoma, would you consider omitting nodal RT and treating only the rectal bed with adjuvant chemoradiation therapy when a large number of nodes have been removed and all found to be negative?
If the decision has been made to treat the patient with adjuvant chemoradiation, I would treat the nodal regions as well as the primary operative bed, as has been done in the seminal trials on rectal cancer. The value of radiation is in preventing a pelvic recurrence that would be hard to salvage. T...
How do you approach a patient with metastatic rhabdomyosarcoma complicated by sinusoidal obstruction syndrome (SOS) after neoadjuvant chemotherapy and radiation therapy?
This is a challenging and unfortunate complication of therapy. Based solely on the information provided and with only 3 fractions left, it sounds like the patient received the majority of radiation therapy, and I would forgo the remainder despite the recovery on defibrotide. However, I would conside...
For locally advanced rectal cancer, would you consider utilizing the RAPIDO trial approach of short course radiation followed by neoadjuvant chemotherapy prior to surgery?
RAPIDO trial is an important study since it is the first phase III study that reported final results of a total neoadjuvant treatment (TNT) approach for rectal cancer.The RAPIDO study is a European study and we need to be aware of the practice difference (in the US, we traditionally use neoadjuvant ...
What is your preferred setup/immobilization for patients with cutaneous malignancy of the toe involving the medial aspect of the digit?
I prefer surgery.
How do you manage early and symptomatic fibrosis in lung cancer patients after RT?
Fibrotic changes following lung radiotherapy are common, and I think the challenge here is determining whether the pulmonary symptoms are due to radiotherapy (pneumonitis) or exacerbation of underlying pathology.Initiating a patient on steroids is typically a several week commitment, with subsequent...
How do you manage leptomeningeal disease in relapsed rhabdomyosarcoma?
I recently had such a case and consulted with a well-known colleague who only specializes in pediatric oncology. The recommendation was to treat with 30Gy in 10 fractions with CSI, which I did. The patient is 5 months post this treatment and is disease-free in the CNS.
Would you treat extranodal extension WITHIN a matted nodal mass differently than at the surface in the postoperative setting for H&N cancer?
A matted nodes is a poor prognostic factor for both regional and metastatic disease. Our data https://www.ncbi.nlm.nih.gov/pubmed/25914344 shows a high risk of metastatic disease in HPV+ OPC, suggesting a need to intensify systemic therapy. This is supported by additional published data.
How do you approach adjuvant therapy for treatment of a high-grade astroblastoma?
Astroblastomas are rare and have historically not been assigned a grade by the WHO but there are plenty of cases where more malignant behavior has been observed. We now know that this is due to the fact that multiple types of tumors can have the characteristic astroblastoma pseudorosettes which have...