Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a slowly progressive benign brain tumor located near critical structures such as the optic chiasm/brainstem?
This is a very common occurrence, except that frequently we don't have histology. For example, meningiomas in the region of the cavernous sinus are frequently diagnosed by imaging criteria. In any event, I recommend radiation therapy for slowly growing asymptomatic, presumed benign tumors that are n...
In patients getting concurrent chemo-immunotherapy for locally advanced cervix cancer, would you hold immunotherapy during the 2.5-3 weeks of brachytherapy?
Pembro is continued throughout the course of treatment. Initially, every 3 weeks for 5 cycles with concurrent chemo RT plus brachy and then every 6 weeks for 15.
For primary CNS lymphoma, when do you refer for whole brain radiation therapy (WBRT)?
When data are limited, consensus guidelines tend to rely on the personal clinical experiences of the guideline committee members. That may explain the NCCN guidelines. Recently, remarkable progress has been noted in the treatment of CNS lymphoma with drugs alone. Ibrutinib is particularly effective ...
Are you comfortable combining relugolix with enzalutamide or abiraterone?
I usually avoid these combinations. The challenge is that relugolix is not superior to other ADT methods in terms of efficacy (at least based on available data) but there are safety issues with considering these combinations. All three of these medications are substrates for similar enzymatic metabo...
When do you recommend post-operative radiation therapy for extracranial chondrosarcoma?
When an en bloc resection with negative surgical margins is not achieved. Typically, this means tumors of the axial rather than appendicular skeleton, as margins are typically wide in the latter. There is "oncolore" that chondrosarcomas are radioresistant tumors. This is likely true at lower pallia...
Do you offer APBI for patients with invasive disease if there is high grade DCIS present in the lumpectomy specimen?
In these situations, I am still comfortable offering PBI to patients. DCIS is seen with invasive disease in a fair number of cases so this comes up frequently and as long as other criteria are met, I view this as appropriate for PBI.
When you do recommend conventional fractionation over moderate hypofractionation for prostate cancer?
I am routinely using 2.5-3 Gy in patients with low, intermediate, and some high risk patients so I guess I am an early adopter (or a cavalier nutjob). The exclusion criteria from the two published non-inferiority trials of moderate hypofractionation that are relevant to this question are quoted more...
Do you offer postoperative radiation for adrenocortical carcinoma?
I just answered a similar question asking about ACC s/p resection with a positive margin, but the same principles apply here: Adrenocortical carcinoma is a very rare entity, and it is associated with a poor prognosis. I have only treated a few. Despite aggressive resection, there is a high rate of l...
Do you recommend adjuvant XRT for adrenal cortical carcinoma s/p resection with a positive margin?
Adrenocortical carcinoma is a very rare entity, and it is associated with a poor prognosis. I have only treated a few. Despite aggressive resection, there is a high rate of locoregional failure. The data regarding adjuvant radiation after surgery are very limited, mostly small retrospective studies....
When do you initiate vaginal cuff brachytherapy treatment after hysterectomy for early stage endometrial cancer?
We usually start vaginal cuff treatment 5-6 weeks after hysterectomy. If adequately healed, may start at 4 weeks but not before. Rarely more than 8 weeks. For patients receiving vaginal cuff treatment plus chemotherapy, we still give cuff treatment within 6 weeks. There is no reason to delay because...