Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you decide on the sequence of systemic and local therapy for patients with oligometastatic NSCLC?
Since patients are already metastatic, systemic progression is the deadliest threat to these patients, so systemic therapy is most important. It will help select out patients with favorable biology that may benefit from aggressive local treatment. The trial that showed a PFS benefit sequenced system...
How long after the presentation of Graves ophthalmopathy is orbital radiotherapy helpful?
Radiation dose helps with graves disease. In the past, we have used 20 Gy in 10 fraction, but there are recent reports of using very low doses as anti inflammatory, like .2 Gy to 1 to 2 Gy total dose with good efficacy and limited or no side effects.
How does a prominent component of intraductal spread affect your management in a patient with otherwise intermediate-risk prostate cancer?
There are no outcome studies that I am aware of that indicates that an intraductal prostate cancer alters prognosis in men receiving radiation therapy. However, there are numerous reports that this is an "adverse feature" when looking at initial staging (men with this finding seem to be more likely ...
How would you treat an excised T1N0M0 anal canal well-differentiated squamous cell carcinoma with positive microscopic margin?
As you said, the data is very limited for this set of patients.The data from the 1980s indicates that even T1N0M0 patients fare poorly with surgery alone (Greenall, Hardcastle) with local control and survival rates being far below what is seen with modern series treated with chemoRT, and thus is not...
Do you give radiation concurrently with adjuvant pertuzumab in locally advanced Her2 pos breast cancer?
I am in agreement here. Women with lumpectomy on APHINITY were encouraged to get simlutaneous radiation and traztuzumab/pertuzumab; there did not appear to be any increase in cardiac or other side effects over the traztuzumab arm of the trial in these subjects.
How would you treat a patient who had bilateral mastectomies for a bilateral squamous cell carcinoma of the breast with a positive lymph node?
This is aggressive variant of metaplastic carcinoma with a high risk of locoregional and distant metastasis despite treatment. I would treat chest wall and axilla for sure and would add supraclav field if the axilla nodal burden is high. ‘I would treat to 60 Gy in 30 fractions
How do you manage patients with primary refractory Hodgkin lymphoma?
Without advising directly on this particular case, which is difficult to do without more information, a few principles in lymphoma management may be helpful: 1. Whenever there is discordance in the clinical picture, or whenever initial management would be drastically changed, it is always prudent to...
How do you approach boosting a distal vaginal tumor (residual thickness >5mm) abutting the rectum?
I have used multichannel cylinder with or without freehand or template based on location and residual thickness. The needle would not be in rectum or abutting rectum as that would create hot spot in rectum increasing risk of complications significantly Need to make sure no hot spot in rectum and pre...
Do you routinely screen for pituitary dysfunction after radiation therapy for nasopharyngeal cancer?
I don’t, only if symptoms
How do you counsel young and educated patients with non-metastatic breast cancer who choose non-proven "natural" treatments over standard therapy?
It is extremely difficult to persuade individuals skeptical of medicine to make evidence-based decisions. Most research related to changing scientific beliefs come from literature related to antivaccination attitudes. Previous research has suggested that provaccine messages about safety (messages co...