Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you follow patients with differentiated thyroid cancer that no longer picks up iodine after thyroidectomy and RAI, and have thyroglobulin antibodies?
The presence of antibodies makes measuring the thyroglobulin level essentailly inaccurate. PET imaging may have a role though clear data on its utlity is limited (and it's expensive). Physical exams and Ultrasonography is the best way of monitoring the disease state from a surveillance point. For sy...
When should post-op RT be offered in patients with recurrent papillary thyroid carcinoma that no longer takes up iodine?
Non-iodine avid, otherwise well-differentiated thyroid cancers have traditionally been considered a reasonable target for external beam radiotherapy. In my practice, XRT is considered once the disease is no longer considered amenable to non-morbid surgery. However given the rise of endocrinologic on...
Given the results of the GETUG 14 randomized trial presented at ASCO 2016, should all men with intermediate-risk prostate cancer receiving dose-escalated radiotherapy receive concurrent ADT?
Neither the GETUG 14 or EORTC 22991 study just published in JCO are mature enough yet to fully answer the question based on endpoints of death from PC and/or overall survival.The third study looking at this is RTOG 0815 which also is not mature yet.It is likely that men with favorable int risk can b...
Should local consolidative therapy be offered to patients with oligometastatic NSCLC who do not progress after induction systemic therapy?
We were one of the three sites that accrued patients to this trial, and the benefits are compelling (a tripling of PFS, along with an OS benefit). Randomized phase II trials are usually not meant to be definitive, but these results are very informative for clinical practice. It's also important to n...
For what stages of primary vaginal cancer do you typically recommend concurrent chemotherapy with external beam radiation therapy?
We follow the same principal as cervical cancer and offer CRT for stage II cancer and greater, as well as, for node positive disease. We looked at NCDB database and there was increasing use of concurrent chemo for vaginal cancer with positive effect on survival
How should RT be combined with immunotherapy to generate an abscopal response?
This is a difficult question to answer because cancer "immunotherapy" is really a variety of heterogeneous therapeutic approaches. Nevertheless, I am aware of no consensus that specifies the optimal radiotherapy dose, fractionation, timing, or target, when used in conjunction with any specific form ...
When do you recommend a breast MRI for breast cancer surveillance?
MRI is a routine part of the work up (this would not be screening) for women presenting with axilary nodal disease and occult primary. In the era of MRI the incidence of so called occult primary has gone down becuase of higher sensitivity of MRI As far screening is concerned, it is approved for high...
What is the best way to discuss an early palliative care referral with a patient?
Patients (and providers) often struggle with the assumption that palliative care implies end of life care. While that is true in many cases, if you can overcome this false assumption, your patients can benefit. I often explain that palliative care like this: Palliative care serves as an extra set of...
In what situations will you defer SRS for newly detected brain metastases in a patient with an oncogene driven malignancy?
We have deferred RT only in situation where there is open clinical trial (we had one with oral Her2 new agent for asymptomatic brain metastases and there are other ongoing studies). Outside of a clinical trial, we offer RT upfront rather than waiting for response from systemic agent.
Should patients receive PMRT if they just have a positive internal mammary lymph node on imaging and a negative axillary dissection?
I also agree with treating all the regional lymph nodes areas when IMN is positive and axilla is negative. Although a lot of data point towards the risk of having positive IMN increases with the presence of positive axilla, there are situations where the axilla is negative and the IMN is positive (d...