Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Would you offer partial breast irradiation for a patient who otherwise meets PBI guidelines but has a PTEN mutation?
I would say increased risk of new primary in residual breast tissue, like BRCA mutation, and for that reason would recommend whole breast over APBI.
Do you still recommend SBRT for oligometastatic and oligoprogressive breast cancer after the abstracts of the BR002 and CURB, respectively?
"Absence of evidence is not evidence of absence." The negative trials have put a damper on enthusiasm for these patients. This is interesting in light of past training and thinking where breast cancer patients with solitary or few metastases were thought to be emblematic of those that we could poten...
What are your top takeaways in Medical Oncology from SABCS 2024?
I would give the following studies the top 3 in terms of impact: GS2-12:The PATINA study, that tested the use of palbociclib in patients who were on maintenance first-line therapy after induction therapy for metastatic HER2 and hormone receptor-positive breast cancer with taxane or vinorelbine plus ...
How do you approach post-operative SRS for resected brain metastases in the presence of residual disease?
I try to dose-escalate to gross disease, based on first principles. Of course, there is not exactly a standard dose and fractionation for SRS/SRT, so judgment is in play for each case based on size, location, and maybe histology. Still, homogeneity is not a priority for SRS, and it makes sense to pu...
Is it possible to use radiation to treat Morton's neuroma in a patient who continues to have symptoms after steroid injections and alcohol ablation?
I just got a consult for this very diagnosis. I've been treating a lot of arthritis/tendonitis/bursitis in the past 2 years, and since MN is also an inflammatory condition, I am going to treat it similarly. Did you end up treating your patient?
How should verrucous carcinomas of the head and neck be managed?
This is a very interesting question. Most of the data and information regarding the management of this entity is obtained from case series and small retrospective series. There are 3 main issues to consider with regards to the use of radiation therapy for verrucous carcinomas of the head and neck. C...