Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend self-breast exams to your patients with history of breast cancer in addition to imaging surveillance?
This is a somewhat controversial question. I cannot find any data on the risks or benefits of counseling on self-exams in breast cancer survivors. I will simply say this. Among survivors, there are differences between patients that I think the physician must understand and meet the patients where th...
How do you treat a high grade prostate cancer with bulky direct bladder invasion?
Interesting to see a treatment paradigm presented where an insurer would fathom A) protons and B) fluciclovine for staging, and C) second generation anti-androgen on top of LHRha to treat a locally advanced, non metastatic prostate cancer. I agree that there is the possibility that some of these thi...
How do you approach cranial radiotherapy in a patient with a cochlear implant?
There are a number of studies that show that cochlear implants can tolerate high doses of radiation. For doses that we typically use, there does not appear to be a major decline in performance when exposed to radiation, either with conventionally fractionated doses or SRS doses. https://www.ncbi.nlm...
What are the indications for postoperative radiation for extramammary Paget's disease?
This is a very interesting rare disease, and a great question. We have had a relatively high volume of these cases come through our dermatology department. First of all, it must be invasive extramammary Paget's disease to even consider radiation. Second of all, the workup must include screening for ...
Would you consider partial breast irradiation in patients who otherwise meet PBI guidelines who have a pathogenic variant of CHEK2 or other moderate penetrance gene?
I would favor whole-breast RT. Although we don’t have data on moderate penetrance genes, in BRCA mutation even whole breast prophylaxis data suggests less risk of a second new primary in these patients. Evron et al., PMID 30475942
How would you treat a patient who has a large DCIS status post mastectomy and implant with extensive positive margins?
I would treat with PMRT to 50 Gy in 25 fractions followed by boost as it looks like the patient has a significant margin positive.Based on the location of implant (pre pectoral or retro pectoral) contouring and at risk volume is different. The consensus guidelines addresses this: https://www.ncbi.nl...
Would you dose escalate neoadjuvant radiotherapy for T3 and/or N+ rectal cancer in patients who are unwilling or unable to get chemotherapy?
If a patient with rectal cancer is not able and/or unwilling to receive concurrent radio-sensitizing chemotherapy with pre-operative intent radiotherapy, I would recommend the use of short-course radiotherapy with 25 Gy in 5 fractions.Multiple trials, including TTROG 01.04 and Polish 1 Bujko et al.,...
Would you recommend MRI post surgery and pre-irradiation for patients with extensive DCIS and close margins and how would it impact your management?
MRI post-op may be hard to interpret. Favor mammogram especially if had microcalcifications pre-surgery, it makes sure they are all removed.
Does location of an non-spinal osseous metastasis affect your SBRT dosing?
Just a few thoughts: Location is an important consideration for SBRT dosing because normal tissue tolerances vary by organ/location. Three complications that I worry about are the risk of bone fracture, neuropathy and myositis when treating non spinal osseous mets with SBRT, especially in the settin...
For AYA patients with early-stage Hodgkin's lymphoma being treated with ABVD, how many cycles of chemotherapy do you administer, and when can radiation be avoided?
It depends - favorable/unfavorable, distribution of disease, co-morbidities, gender, family history, etc. I don't treat pediatric patients, so the comment below applies strictly to young adults.If a patient has early-stage, favorable HL per GHSG criteria (no risk factors), then 2 cycles of ABVD + 20...