Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider concurrent chemoRT for unresectable bladder adenocarcinoma?
The simple answer is YES. If unresectable then follow the established treatment paradigm of maximal TURBT followed by ChemoRT. Platinum based regimens are typically the standard with good evidence for alternative schedules such as 5FU/mitomycin or Gemcitabine (low dose). This is s potentially curati...
Do you prescribe prophylactic steroids with spine SBRT?
I do not use prophylactic steroids for spine radiosurgery. I indeed start tapering steroids from the time of consultation if the patient was already on steroids. After radiosurgery of spinal cord compression, I start tapering on the day of radiosurgery.Pain flair seems to occur in 10-20% of patients...
How do you handle the situation where a curative-intent patient unexpectedly passes away while under treatment?
As many of the patients we treat are older and have numerous co-morbidities, this is not that rare an occurrence. Of course, we would presume to avoid treating patients with curative intent if it is readily apparent that their life span will be short due to other non-malignant illness. That said, I ...
Is SBRT appropriate for a small endobronchial tumor distal to the proximal bronchial tree?
In my opinion, you can approach them like any other peripheral NSCLC. There are challenges with small tumors in terms of finding them on CBCT sometimes and getting the dose in if they are very small. The 0236 protocol mandated a minimum aperture of 3.5 cm, which made it not very useful to treat tumo...
Does p16 status (HPV) influence your decision on whether to offer adjuvant chemoradiation or radiation in node positive H&N cancers?
No, p16 status should not influence the decision for initiating adjuvant therapy as p16+ patients have similar risks for failure after surgery as p16- patients without adjuvant care. Whether these patients may receive de-escalated therapy as part of a clinical trial is a separate question from wheth...
Would you treat the chest wall alone in a patient that had a previous prophylactic mastectomy and later developed an early stage breast cancer pT1-2N0 after a "lumpectomy"?
If nodes are not assessed surgically this time, I would treat level 1 and 2 for sure with supraclv based on other risk factors.
Would you offer radiation to the contralateral breast if after neo-adjuvant chemo and prophylactic contralateral mastectomy yielded ITC only in a single lymph node and no breast primary?
Other factors would influence my decision. What was the burden of disease for starting NACT on ipsilateral side? Could this be spread from the contralateral breast to the lymph node? Was MRI imaging done prior to chemo? Did staging show any enlarged contralateral node? Pre-treatment work-up/findings...
Which chemotherapy regimen do you prefer for concurrent treatment with radiation therapy for anal squamous cell carcinoma?
When you have a highly successful treatment such as radiation with concurrent mitomycin and 5-FU in a rare disease such as epidermoid carcinoma of the anal canal, it is extremely difficult to improve outcomes by improving the chemotherapeutic/radiosensitizing effect. The recurrence rate is so low no...
What palliative radiation dose would you give to a patient with vulvar cancer who has an inguinal recurrence in a field previously irradiated with 45 Gy?
If only site of relapse, I would treat with definitive doses to the volume based on previous treatment and use conformal RT to avoid femoral head and neck region.
What combination of clinical and pathologic features would lead you to be comfortable recommending active surveillance in a Gleason 7 prostate cancer patient?
Active surveillance (AS) is an important option for prostate cancer patients, especially for low risk prostate cancer. For intermediate risk prostate cancer, the risk of AS increases somewhat but the benefits of AS remain. To keep the risk of AS acceptable, one should select intermediate risk patien...