Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for Radium-223 in patients that have a non-prostate malignancy who otherwise would be a reasonable candidate?
At present the only approved indication for Radium-223 is in castrate resistant, symptomatic bone mets from prostate cancer. We do have open study evaluating efficacy in hormone positive breast cancer with metastases to bone.
Do you have any advice when utilizing palliative radiation therapy in patients currently being treated with a PARP inhibitor?
This is an excellent question and certainly will become more of an issue with the recent FDA approval of olaparib for HR-defective (HRD) metastatic ovarian cancer. In addition, many other HRD metastatic cancers are being treated with this drug under compassionate use. Furthermore, the recent Phase I...
When should multiparametric MRI (mpMRI) be utilized in prostate cancer workup?
Early adopters of prostate mpMRI are unique and always a pleasure to meet. I've learned a great deal from many of them. They’ve moved beyond aiming at a CT density in the pelvis and learned how to use mpMRI sequences to better classify the risk of disease they’re treating. This is in comparison to o...
What would your management approach be for a patient with high grade large cell neuroendocrine of the lung, status post resection with negative margins, but visceral pleura invasion noted on path?
At present, the role of post-operative radiotherapy (PORT) has been shown, but not definitely proven to be detrimental for patients with resected NSCLC with N0 and N1 involvement by retrospective reviews of the ANITA trial and the SEER database (Lally et al J Clin Oncol 2006; 24:2998-3006), as well ...
What is the role of surgery in patients with Stage III NSCLC and N2 positive lymph nodes?
Interestingly: Patients that were to get lobectomy has survival of 2.8 years with surgery and 1.8 years with CRT However, for pneumonectomy patients, patients treated with surgery had survival of 1.6 years while those treated with CRT had a survival of 2.4 years. So.. patients with disease that see...
For a patient treated with Mohs surgery for a high risk skin cancer of the head/neck do you post-operatively treat all scars to full dose, including those created at subsequent closure?
There are a few high quality studies of adjuvant radiotherapy to the site of a primary skin cancer that help guide the answer to your question that I am aware of. Based on first principles, it would seem like the area that the tumor originated, as well as the surrounding area at risk for subclinical...
How common is hypothyroidism in postradiation head and neck cancer patients?
The incidence of postradiation hypothyroidism is hard to determine, as the literature is quite varied. This variation is due to a combination of how hypothyroidism is measured, how much of the thyroid was treated, and when patients were assessed. Recent literature suggests the incidence can approxim...
Is there any role for SRS+WBRT for patients with a limited number of small brain metastases?
The recent publication from Dr Brown confirmed the finding from prior studies, that omitting upfront whole brain RT doesn't compromise OS in patients with limited brain metastases. More importantly, this second study had neurocognition as the primary end point, and confirmed better neurocognition pr...
Has SBRT shown to improve OS or PFS in patients with localized pancreatic cancer who are not a eligible for surgery due to other comorbidities?
No. 33Gy / 5 fx, "Low-dose palliative SBRT" may not help at all. In spite of what you will hear many radiation oncologists tell you, it is a palliative therapy with similar overall survival to 50.4Gy in 28 fractions in every study of usually highly selected patients. It's only more convenient and le...
What is the role of up-front neck dissection in locally advanced head and neck squamous cell carcinoma?
The place of neck dissection (whether performed before or after definitive chemoradiotherapy) in the treatment of advanced head and neck cancer continues to be debated, with wide institutional variability in practice. Prior to this recent randomized trial from the UK published in the NEJM (N Engl J ...