Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For concurrent chemoradiation in head and neck cancers, how important is the timing of weekly radiosensitizing cisplatin early versus late in the week?
Our protocol for concurrent cisplatin-RT demands that the drug will be infused 1-2 hours before RT, usually on Mon. The assumption is that it will allow maximal drug concentration in the cancer cells at the time RT is delivered after chemo on that day, early in the week, while some radiosensitizatio...
Would you offer 12-16 Gy in a single fraction for a symptomatic, non-vertebral bone metastasis?
Yes.We have randomized, prospective studies indicating that dose-escalation with 1-2 fractions improves control of pain over conventional RT doses - here and here. We also have a meta-analysis showing higher chance of complete response of pain with SBRT. In addition, the Canadian investigators showe...
When do you offer adjuvant radiation therapy for a glomus tumor of uncertain malignant potential of the extremity resected with negative margins?
No, unless malignancy is documented.
How would you treat a second HPV related oropharyngeal squamous cell cancer in a patient previoulsy treated and cured of a HPV related SCC of the tonsil treated with chemoradiation?
At our institution, recurrent or second primary head and neck cancers are discussed at a multidisciplinary tumor board whenever possible. We review prior radiation records, physician's notes, and pre-treatment imaging to attempt to come to a consensus whether it is truly a second primary or perhaps ...
How do you manage anticoagulation for patients with DVT/PE who have brain metastases?
Not all brain metastases pose the same risk to patients. Rapid, numerous (even if tiny), new onset metastases from RCC or melanoma (especially BRAF mutant) can go from asymptomatic to life threatening hemorrhage within 1-2 weeks and I would strongly caution anti-coagulation in these patients. If the...
For esophageal cancers with large gaps between the primary and PET positive lymph nodes, do you treat the gaps with continuous volumes or only involved areas?
As is true for much in medicine, there is no simple answer to this question. For a patient with a cervical esophageal cancer, perigastric lymph nodes are essentially metastatic. There is no clear dividing line as to when a node is metastatic vs regional disease. We know that for tumors of the lower ...
Would you recommend adjuvant radiation therapy to a T4N0 colon cancer with invasion into other organs or the abdominal wall status post R1 resection?
Given the relative dearth of data for radiotherapy in the management of T4 colon cancer, one of my residents, Dr. Chris McLaughlin just completed and published a SEER database analysis on this population of patients (McLaughlin et al. Radiother Oncol 2019). He found that only about 5% of patients wi...
Does the presence of thrombus in the sinus affect your decision between fractionated radiation and SRS for recurrent grade 1 meningioma?
The presence of a thrombus in the venous sinuses can be a significant risk factor for post-treatment complications after SRS for meningiomas originating near or attached to the sinuses. Venous sinus thrombosis can be increased by the SRS, leading to venous infarction, which can cause a range of neur...
In patients with vertebral bone metastases, what criteria do you use to select patients for kyphoplasty referral prior to palliative radiotherapy?
In patients with painful malignant verterbral fracture without overt instability or neurogenic compression that would warrant surgical consultation, kyphoplasty can be considered either before or after palliative radiotherapy. Vertebral augmentation to achieve immediate pain relief prior to radiothe...
Would you consider RNI alone without CW for an isolated nodal recurrence after treatment with mastectomy and SNB for an early-stage breast cancer with no prior RT?
I favor comprehensive RT unless there are contraindications or the patient declines because of the impact on cosmetic outcome.