Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the best treatment for a Head and Neck cancer in a patient with Parkinson's disease with nuerostimulators located in the clavicular region?
I have treated patients with neurostimulators although have avoided any direct exposure of the device in the treatment field. The company guidelines recommend no direct RT exposure and to always switch off these devices during the time patients were in the treatment room and RT was on.
Would you treat a patient with HIV or hepatitis C with an anti-PD-1 agent?
Yes, anti-PD-1 agents can be used in patients with HIV or hepatitis C if the viral infection is well controlled. In preclinical studies, PD-1 blockade has been shown to be a promising immunotherapy for HIV and Hepatitis C. This is based on the observation that progressive loss of effector function i...
Would you consider SRS of non-progressive, stable intracranial lesions while treating with SRS for a single progressive brain metastasis after previous WBRT for multiple brain metastases?
An interesting question and clinical scenario. My default advice for this situation would be to focus on the progressive metastasis only to achieve treatment related goals for local control and symptom palliation (while reducing treatment related toxicity) and reserve further SRS to the additional l...
Given the significant risk of recurrence after chemoradiation for locally advanced anal carcinoma, should resection be considered (with or without neoadjuvant treatment) in select cases?
Interesting question. As a practical matter, many of the tumors that start out unresectable get replaced with dense fibrosis--and, therefore remain major surgical challenges even if there's residual cancer within the fibrosis. Many people argue that, since anal cancer can be slow to manifest complet...
In a patient with stage III-IV p16+ oropharyngeal cancer undergoing definitive CRT who is unable to maintain nutrition, would you rather consider stopping treatment early (to an investigational de-escalated dose) or insert a feeding tube/take treatment breaks in order to complete the full dose?
Off protocol, we should complete the course of chemo radiation, so feeding tube if needed. I would try aggressive hydration first, if possible.
How do you account for artifact due to hardware, or what measures do you take, to optimize planning in the setting of a post-operative spine SBRT treatment?
The most difficult issue from artifact from hardware is adequately seeing the spinal cord for proper delineation. In order to properly see the cord in cases where artifact from MRI obscures the cord, we typically obtain a CT myelogram and fuse that with our simulation CT to allow us to draw out the ...
Does p16 status influence your decision when choosing between surgery and definitive chemo-RT for head and neck patients?
I am assuming that when you say "surgery" you are specifically referring to transoral robotic or transoral laser surgeries and not the traditional mandible- splitting surgeries for oropharyngeal cancers.Currently p16 status does not make a difference in offering transoral surgery to patients. FDA ap...
How would you treat small cell cancer of the cervix?
Small cell carcinoma is a rare tumor, representing less than 3% of all cervical cancers. It is tremendously different from the more common squamous and adenocarcinomas of the cervix both in terms of histological identification and its clinical course. Due to its rarity and variable inclusion on prev...
In what situations should chemotherapy be added to adjuvant radiation therapy in a resected vuvlar SCC?
We did analysis from NCDB and saw significant trend of use of concurrent chemotherapy for node positive disease and its positive impact on survival. That being said these studies have their own flaws. In practice we do add concurrent cisplatinum for node positive patients if performance status allow...
Are there technical alternatives to SRS for a radiation center without the requisite micrcollimator or cones, for patients with early crainal merastases?
I would consider fractionated stereotactic radiotherapy if microcollimator or cones were not available for limited brain metastases.