Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For LS-SCLC with radiographic CR after chemotherapy, is there a time point beyond which you do not offer radiation if there is a delay in initiation of radiation?
I don't think we really have any data guiding this scenario. We know that optimal benefit is achieved when definitive RT is given within the first 2 cycles of chemo. However, I don't think that chemo alone is adequate for total eradication of disease. If the patient is within 1-2 mos of completing c...
How do you approach treatment of 1p19q non-codeleted high grade gliomas?
The question focuses on the management of 1p19q non-codeleted high-grade gliomas, which for all practical purposes translates roughly to the entity that by legacy terminology has been referred to as anaplastic astrocytoma. This question has come into focus with the recent publication of results of t...
Would you offer APBI in a patient with Paget's disease?
If breast MRI followed by central lumpectomy confirms DCIS with negative margins, then I would offer APBI with the same principle as used for DCIS.
What are the indications to treat Dupuytren's disease with radiation?
I would not offer any radiation therapy after a surgical procedure for Dupuytren's contracture. Should the patient develop recurrent nodules that progress more than 6 months following surgery, then I would consider definitive split-course electron beam therapy to deliver 30 Gy at 3 Gy per fraction w...
Are you covering the tracheostomy site with a surgical mask due to COVID-19 to protect the therapist?
I have not routinely used masks over tracheostomy tubes, but it seems like a good idea in the current environment. Our staff, including physicians, nurses, and therapists, do use masks while taking care of these patients, including during suctioning of tracheal secretions.
What criteria are you using for retreatment with Pluvicto (Lu-177) in those who maintain a good performance status and appropriate lab work?
Mainly, whether or not they've exhausted standard options. At the time I'm answering this, Pluvicto is approved for castration-resistant metastatic disease, either pre- or post-taxane chemotherapy. If they have not had chemo, I usually recommend it. If they have, I get their medical oncologist to we...
What mucosal surfaces do you commonly cover with HPV-positive squamous cell carcinoma of the head and neck of unknown primary?
This is an interesting question. Many radiation oncologists are eliminating the nasopharyngeal mucosa from the field when designing plans for “comprehensive mucosal irradiation” in cases of unknown primary head and neck cancers with HPV or p16 positive squamous histology. I am currently not comforta...
How would you treat synchronous high-risk prostate and rectal adenocarcinomas in an elderly man where the rectal cancer was resected secondary to obstruction (T3N0)?
Start with androgen deprivation. EBRT 45 to 50.4 Gy at 1.8 Gy per fraction to the pelvis. Boost prostate with brachytherapy if feasible or EBRT to somewhere around 80 Gy depending on the small bowel. Adjuvant chemo is unlikely to be tolerated.
How does the presence of indeterminate lymphadenopathy on PSMA PET scan alter your management of unfavorable intermediate-risk prostate cancer?
Summary: In practice, I usually review the imaging myself and attempt to evaluate for common pitfalls of interpretation or evidence that may convince me of a true positive. Often, I find a second review by a blinded radiologist helpful. Unless I am highly suspicious of a false positive, I often err ...
Is there a limit to the size of a prostate cancer oligometastasis for SBRT?
I think that, in general, the direct answer to this is 'no'; there is no specific size cutoff that makes SBRT not feasible in this setting. There is some data in other settings that suggest local control is not consistently impacted by the size of oligometastatic tumors, and there is little data to ...