Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend large-field radiation therapy to treat SCC of the skin with field cancerization (e.g., entire forearm, scalp) in elderly patients with CLL/immune compromise who have had mixed responses to cemiplimab?
Yes, retrospective data from Australia support large fields using VMAT at a median dose of 47.9 Gy in an average of 23.9 fractions with treatment breaks as needed and using a custom bolus. The photos in the article help clarify what is meant by 'field cancerization.' This phenomenon is termed extens...
Is there any way to safely treat patients with mCRPC with 177-Lu PSMA who are on hemodialysis?
For the most part, no. Not unless you're a big academic medical center with a robust multidisciplinary team willing to tackle the significant logistical challenges associated with this scenario.I'm aware of no literature in this scenario specifically for Pluvicto, but we can look at the radiopharmac...
Is it necessary to treat the entire larynx with intermediate or elective dose in a T1/T2 squamous cell carcinoma of the supraglottic or subglottic larynx?
It would be hard to miss it without missing your target. Additionally, you have level 6 nodes with the subglottis and levels 2-4 with the supraglottis. Not a great idea. To clarify, don’t try to spare the glottis.
Do you need renal biopsy before SBRT for RCC suspicious cancer?
Yes. The teaching is usually that ≈ 20% of small renal masses (<4 cm) are benign, and this rate goes down as size increases (Thompson et al., PMID 19286217). Features such as contrast enhancement, tumor location, and sex can help to improve the malignant risk potential of these lesions, but no combi...
Is it feasible to treat central liver tumors +/- portal vein thrombus with SBRT while minding central hepatobiliary tract constraints?
Remember that biliary strictures frequently cause death in these patients because stents don't always drain after these high doses of radiation. I have personally never caused a biliary stricture. The regimens that I am using with an SBRT technique are below the threshold for biliary stricture and r...
When is it appropriate to recommend SBRT directed to sites of oligometastasis (ex, single adrenal met) for a patient with extensive stage small cell s/p chemo and PCI?
May I play devil's advocate for one moment? I don't wholly disagree with @Dr. First Last btw, fwiw.1) Some people with SCLC can be cured. It appears that the application of a local therapy in limited stage SCLC increases the chance for long-term DFS (aka "a cure"). Five-year survival was doubled fro...
Have the results of the OPRA trial influenced your decision to recommend long course chemoradiation vs short course radiation therapy for patients receiving TNT who intend to undergo surgery?
The TME-free survival rate in the OPRA trial has solidified chemoradiation followed by consolidative chemotherapy as a standard in our practice. However, since the principal investigator is at our institution, it just meant that we continued doing what we were doing. It is important to realize that ...
How do you approach prostate cancer patients who have hypertestosteronism on pre-treatment labs?
This is rare and full disclosure - I have not personally experienced this situation and this answer is based on discussion with colleagues. I suspect whatever the true incidence is, it is likely detected in only a fraction of patients as ADT is often initiated without drawing testosterone levels, an...
How do you avoid epilation in patients hoping to preserve their facial hair during radiotherapy?
Interesting question. I have not created an avoidance. It’s my experience that doses of about 50 Gy+ commonly cause permanent hair loss. It’s hard to avoid hair loss in areas where elective nodal or mucosal/skin coverage is needed. It’s certainly disappointing for some patients. In many scenarios of...
How would you treat a schwannoma of the breast with a positive margin that is not amenable to re-excision?
If it's pure schwannoma, it's benign pathology, and I would not do anything for microscopic residual disease.