Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How does triple-negative status influence your management of ET?
This is a fantastic question! First, I would ensure that the patient has triple negative ET (or pre-fibrotic PMF) and not a secondary cause for thrombocytosis. This requires a bone marrow biopsy and a careful examination with hematopathology to ensure there are morphologic features consistent with a...
How does triple-negative status influence your management of ET?
This is a fantastic question! First, I would ensure that the patient has triple negative ET (or pre-fibrotic PMF) and not a secondary cause for thrombocytosis. This requires a bone marrow biopsy and a careful examination with hematopathology to ensure there are morphologic features consistent with a...
How would you manage a middle thoracic esophageal squamous cell carcinoma (tumor is 25-30 cm from carina) with a positive supra-clavicular lymph node?
For Proximal/Mid Thoracic ESCA, supraclavicular node is considered a regional node, and therefore part of the AJCC N1-N3 staging system, and should be managed with locoregional treatment, using preoperative or definitive chemoradiation, to 50-50.4 Gy in 2.0/1.8 Gy per fraction. The node could be tre...
What dose/fractionation do you like to use for palliation of bulky LAD from CLL/SLL?
I have treated patients with bulky mass(es) - mostly parotids of recent. Bulky mass(es) -> I like either 400cGy x1 but most use 200cGy x2 (mostly used by me) -> (Electrons for structures like the parotid, but photons for deeper stuff.) For example, when I treated a few parotids glands, they were swo...
What clinical parameters determine when you treat a large HCC lesion with ablative radiation vs Y-90?
Based on 3 negative randomized trials that have compared Y-90 to relatively inactive targeted therapy (Sorafenib), Y-90 has no evidence-based role in the treatment of HCC. In fact, systemic therapies have improved and 3 regimens have shown a survival benefit for locally advanced and metastatic HCC. ...
Does the use of A+AVD versus ABVD affect your decision for consolidation RT for bulky Hodgkin lymphoma?
A+AVD is an acceptable regimen for advanced HL based on results from the ECHELON-1 study (Ansell et al., PMID 35830649) showing an improvement in both PFS (82% vs 75% at 6 years) and OS (94% vs 89%) compared with ABVD. Radiation therapy was not incorporated into this study.In advanced HL, regardless...
For a patient post-prostatectomy with a high PSA (>1), a negative MRI pelvis, and a negative PSMA PET scan, do you pursue any other imaging?
The sensitivity of PSMA scan for PSA above 1 is about 75-90%. I would proceed with salvage RT plus ADT like we did in the era when PSMA was not available.
Do you routinely start anticoagulation for a patient with newly diagnosed hepatocellular carcinoma presenting with a portal venous thrombosis?
No. Anti-coagulation is generally not indicated. Anti-coagulation is usually only indicated for acute PVT causing symptoms. This is more common with underlying thrombophilia. PVT is very common in cirrhosis and anti-coagulation is not required. PV thrombus from tumor similarly is common and anti-coa...
Do you routinely start anticoagulation for a patient with newly diagnosed hepatocellular carcinoma presenting with a portal venous thrombosis?
No. Anti-coagulation is generally not indicated. Anti-coagulation is usually only indicated for acute PVT causing symptoms. This is more common with underlying thrombophilia. PVT is very common in cirrhosis and anti-coagulation is not required. PV thrombus from tumor similarly is common and anti-coa...
Do you offer prostate RT to men with 0-3 bone metastases on conventional imaging when PSMA PET shows a very high number of M1 lesions?
This would be a hard no from my standpoint.I get the rationale here. STAMPEDE found a survival benefit for prostate-directed RT in men with "low volume" disease, which was defined based on the CHAARTED trial with conventional imaging. Therefore, men with low-volume disease on conventional imaging fi...