Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach treatment of a subtotally resected low grade glioma in a young patient?
The management philosophy for LGG is radically shifting. For years, the belief was that these were essentially "incurable", slow-growing tumors, and hence the original debate centered around observation versus resection; the observation camp is now squarely in the minority. The debate then shifted t...
Are there any unique considerations for treating pediatric high grade glioma?
Trial availability, disease extent, age, specific molecular alterations, and family history should likely all play a role in choosing the most appropriate treatment paradigm.It’s expected that most future studies in pediatric high grade glioma will be stratified by their nascent biology, given that ...
Would you offer hypofractionation for a larger AVM?
When treating large (or giant) AVMs the dose-volume relationship can be unfavorable when using a single-session radiosurgery, resulting in high complication rates for effective dose. The obliteration rate for large AVMs treated with single fraction SRS is low (less than 50%). For this reason, other ...
Do you use any dose constraints for the spleen while delivering abdominal radiation therapy?
The prognostic impact of post-RT lymphopenia on overall survival has been suggested by studies in esophageal, lung and pancreatic cancers (among others).Sunil Krishnan and others at MDACC looked at the relationship between degree of post-RT lymphopenia and mean splenic dose for patients with pancrea...
How do you manage a twice-recurrent mucinous adenocarcinoma of the lower eyelid with direct involvement of the lateral rectus muscle and lacrimal duct?
These are difficult cases. In the past, I have successfully treated a couple of these tumors with neoadjuvant immunotherapy, which allows for reduction in tumor volume to allow for an eye-sparing surgery. Because the orbit is involved, radiation should not be given due to the profound complications ...
Do you recommend irradiating the remaining penis and pelvis vs pelvis alone in a patient with partial penectomy with negative margins who has multiple, positive groin nodes with ECE?
Generally agree with the comments by Dr. @Dr. First Last. The NCCN guidelines tend to recommend chemotherapy followed by node dissection without planned radiation. Post op XRT is reserved for certain situations (which is very toxic after groin dissection ). I have found that treating the penile stum...
Is there a scenario in which you would consider neoadjuvant radiation for rectal cancer after previous definitive radiation for prostate cancer?
I am inclined to refrain from administering neoadjuvant radiation therapy for rectal cancer in a patient who has previously received definitive radiation therapy for prostate cancer. Instead, for these individuals, neoadjuvant chemotherapy followed by surgery appears to be a more suitable course of ...
Would especially young age (eg 20's) influence your recommendation for breast conservation vs mastectomy in an early stage breast cancer?
For younger patients, as with older patients, the final recommendation is influenced by the discussion of risks and benefits. I have treated women in their 20's with BCS+RT as well as post-mastectomy RT. For those electing BCS, the evidence clearly points to a higher risk of local relapse in younger...
Would you offer prostate SBRT to a patient on a TKI?
I would assume the patient is on a TKI for another malignancy such as RCC, and the question is about treating localized prostate cancer.I ask the medical oncologist for input, and if they agree, I will hold TKI for 3-5 days before and one week after SBRT.This is based on the favorable safety profile...
How does Decipher score inform your practice for treating pelvic nodes in otherwise favorable intermediate risk prostate cancer?
Nodal radiation therapy in prostate cancer remains controversial. While the Decipher score correlates with lymph node involvement in pathological specimens, I have not used it to decide on pelvic nodal radiation. Two randomized studies failed to show a benefit to pelvic radiation (old studies with i...