Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage a prostate cancer patient with pelvic lymphadenopathy and a single enlarged PSMA PET+ gastrohepatic node?
I would treat it as oligometastatic, starting with ADT/ARPI and use metastasis-directed therapy and pelvic radiation.
Are you offering hypofractionated comprehensive nodal irradiation following neoadjuvant chemotherapy for patients with locally advanced breast cancer in the setting of COVID-19?
In locally advanced breast cancer following neoadjuvant chemotherapy, we are offering hypofractionated radiation to the breast and regional nodes, and flat chest wall and regional nodes. In these cases, I treat to 40 Gy/15 fractions. For nodal coverage, I like to see 38 Gy line covering nodal basins...
Do you consider increased tumor thickness alone as an indication for postoperative radiation in oral cavity cancers?
Depth of invasion (DOI )has been shown to predict regional disease. As such, surgeons will use this information to decide if a neck dissection (ND) should be performed in the cN0 patient with oral tongue cancer.With no other adverse features (i.e., no PNI, no LVSI, no poor differentiation, good marg...
In ES-SCLC presenting with extensive brain metastases, how do you time whole brain radiation after the first cycle of chemotherapy has already been delivered?
We typically try to wait as long as possible before we start WBRT. It depends on the burden and symptomatology of intracranial disease as well as the initial response to chemo-immunotherapy. If the brain metastases are asymptomatic and deemed OK to monitor closely (i.e., not likely to cause neurolog...
When would you offer neoadjuvant immunotherapy prior to Mohs surgery in a locally advanced squamous cell carcinoma for which clearance may require enucleation?
I would flip this question around and answer that radiotherapy is often a terrific option around the eyes, and it should always be considered in this area, especially when a radical surgical procedure is being entertained. Between en face therapy with a shield (superficial, electrons) and IMRT/VMAT,...
Would you treat a patient with an N2 ipsilateral recurrence following re-resection of bronchial stump recurrence?
My answer is predicated on the assumption that this patient has not had prior radiation therapy. If that is the case, then I would treat them. It is important to talk to the thoracic surgeon and know how the bronchial stump was "finished". My preference is that it is done with a fresh intercostal mu...
How do you counsel/advise patients when asked to compare ultrahypofractionated radiotherapy with the TULSA procedure?
I start by noting that the three NCCN-guideline recommended management plans for favorable-risk prostate cancer are radiotherapy (including SBRT), surgery, and active surveillance, and the latter two often require additional local therapy to render a patient cured within the next 5-10 years. In gene...
What is your preferred approach for the management of choroidal oligometastases?
We typically treat choroidal metastases with external beam radiotherapy. An argument could be made to treat with systemic therapy in the minimally symptomatic patient that has a high likelihood of response to systemic therapy (for example, ER+ breast cancer). Brachytherapy could be considered for a ...
How do you counsel cancer patients when they ask if they should avoid sugar?
“We don’t have evidence to support any specific diet that can either worsen or improve outcomes. I encourage a healthy, well-balanced diet with my top priority being you maintaining your weight during treatment.” Particularly for my head and neck patients, getting in sufficient calories is of the ut...
Do you omit PMRT for patients who would have been eligible for NSABP B-51, but are found to have significant pure LVSI only, without stromal carcinoma, after neoadjuvant chemotherapy?
I would treat it like a partial response and favor RT.