Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What adjuvant treatment would you recommend for a patient with FIGO 2023 IIIB2 endometrioid endometrial adenocarcinoma (Grade 3, p53mut, MMR proficient), metastatic to the uterine serosa, bilateral ovaries, and anterior peritoneal reflection?
Chemotherapy followed by pelvic RT
What are your top takeaways in Radiation Oncology from SABCS 2024?
Wine regions have good years and bad years. This year's vintage from San Antonio was exceptionally fine, with oral presentations of several important, highly anticipated trials. The second and third of the studies I will discuss were also published on the day of the oral presentation.1. GS2-03: Kunk...
In what patients is it inappropriate to offer DCISionRT testing?
Appropriate or inappropriate... not quite how I think about it. Most of my patients come with it done. Here are various reasons why a low score won't change my mind about whether to treat or not. Large and high grade - i.e., >2.5 cm and grade 3. I don't feel comfortable omitting from this group. Po...
What electron beam dose/fractionation would you use for a recurrence basal cell carcinoma of the scalp adjacent to a split thickness skin graft?
Standard curative dose and fractionation, 6e and 1 cm bolus if superficial lesion, assuming complete healing of the surgical scar.
Would you include the internal mammary nodes (unilateral or bilateral) in the adjuvant radiation field for a small Merkel cell carcinoma located along the sternum on the medial chest wall, s/p R0 resection, but no sentinel lymph node biopsy?
I would consider including adjoining ipsilateral IMN in the volume.
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
How do you monitor for cardiac toxicity in patients taking osimertinib?
There are multiple studies that have explored the issue of cardiotoxicity from osimertinib. A large single-center retrospective observational cohort series from Taiwan, (n=401) compared a matched cohort of patients treated with osimertinib (n=253) to those treated with other EGFR TKIs (n=195) and fo...
Do you need to hold Humira (adalimumab) during radiation for breast cancer in a patient with psoriatic arthritis?
To my knowledge, there is not a lot of data on the interaction of adalimumab or other similar meds and radiation therapy. I am increasingly seeing this in my practice, however, for patients with psoriatic or rheumatoid arthritis. I discuss with patients that we have limited data on potential interac...
How do you select which patients with H&N primary tumors benefit from proton therapy?
Surprising to see that the expert opinion after TORPEdO results is that IMPT is also a great choice. Granted, it contradicts the MDACC-led study, but we should have nuance and critical analyses. The rates of feeding tube dependence in the IMRT arm in the MDACC-led study are astronomical. I have neve...
For vaginal cuff recurrence of an endometrial cancer, when do you utilize a multichannel cylinder versus single channel cylinder if a patient has <5 mm residual disease after EBRT?
If disease is confined to one wall, favor MC applicator as I treat vaginal wall thickness for side involved while surface on other side. MC allows that flexibility.Here is the link to our publicationGebhardt et al., PMID 29929925