Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you prescribe respiratory muscle training (RMT) devices to patients with dysphagia?
We encounter dysphagia frequently in our patients with Parkinson's disease and other movement disorders. If there are any concerns about swallowing or aspiration, my first step is to refer to Speech Therapy for evaluation, and I defer to their expertise for specific treatments from there. That said,...
What pathological factors do you use to consider treatment of the axillary level I/II after an axillary dissection?
We examined the risk of axillary failure in relation to the number of positive nodes AND the number of nodes removed by axillary dissection for patients undergoing mastectomy without PMRT in ECOG patients treated with chemotherapy in trials conducted from 1972-1987 (Recht et al., PMID 10561205). Wit...
How do you manage fatigue in women receiving chemotherapy/hormonal/radiation therapy for breast cancer?
Managing fatigue is challenging for patients undergoing cancer therapy. One of the best ways to increase energy is to exercise. It is a bit of a catch 22, but if you explain to patients they can start out with small goals and there symptoms will improve that can help. A very important contributor to...
What are your target volumes and dose for recurrent atypical meningiomas that have been initially treated with definitive surgery alone?
These questions get to the bottom of several important issues facing patients with WHO grade II meningioma and physicians treating them. Permit me to approach these inquiries as if writing a Scientific American article, answers first, then some abbreviated supporting documentation. Regarding treatme...
How would you manage an enlarging brain metastasis that has progressed in size three months after radiosurgery?
Before making a decision, I would want to know the tumor histology, SRS dose delivered, and whether the current site of progression is truly within the prior radiation field (using new MRI fused to the SRS plan in treatment planning software). If the lesion is within the high-dose region and the pat...
Would you add whole-pelvis radiation as MDT (metastasis-directed therapy) in a patient with 1 pelvic node and 2 osseous metastatic sites for castrate-resistant prostate cancer?
This patient would not fit the PEACE V-STORM eligibility criteria, since the trial excluded patients with distant metastases and did not include patients who were castrate resistant, so I do not think you can extrapolate the results to this patient. One could argue that what you propose to do (SBRT ...
For resected oral cavity squamous cell carcinoma with indication for adjuvant radiotherapy to the primary tumor bed, would you routinely include ipsilateral and/or contralateral nodes even with a pN0 elective neck dissection?
Since the question states "routinely", the short answer is yes, but the longer answer is there is much more nuance to this.Some will say no based on Contreras et al., PMID 31246526.It is important though to recognize that this paper is a bit more complex and the details are critical.The question ref...
How would you approach ES-SCLC presenting with small brain metastases that resolve after chemotherapy?
ES-SCLC may respond to chemotherapy, but save for a select few, it’s a palliative disease with, median survival of about a year for responders. Presenting with microscopic brain disease that responds to chemo does not change that. The Slotman report indicating survival advantage has been questioned ...
In patients with HER-2 positive breast cancer on pertuzumab/trastuzumab with newly developed asymptomatic brain metastases only, do you wait 3 weeks after administration of the targeted therapy to deliver SRS?
In a recently published study from Italy, Ippolito et al., PMID 35053467 a total of 10 patients with 32 HER2+ breast cancer brain metastases were treated with concurrent fSRT (27 Gy in 3 fractions) and Pertuzumab. Necrosis was reported in only 1 of the 32 treated lesions. The study is small but the ...
Should TNF inhibitors be held in patients undergoing radiation therapy?
We do not hold TNF inhibitors when needed for patients undergoing radiation therapy.