Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer consolidation chemotherapy prior to durvalumab in locally advanced, unresectable NSCLC?
I do not offer consolidation chemotherapy to patients prior to durvalumab in patients with locally advanced, unresectable NSCLC. The PACIFIC trial was a randomized phase III trial that established the role of consolidation durvalumab after definitive chemoradiation for patients with stage III NSCLC....
When would you offer single fraction adjuvant partial breast irradiation instead of a 5-10 fraction course for early stage breast cancer?
We have not offered a single fraction, and our standard is 26 to 30 in 5 fractions. Data on a single fraction is not enough to support this recommendation for now.
How would you manage treatment of keloid that is so large it requests a graft?
16 Gy/4 fractions
Does postoperative radiation within 24 hours of a skin graft with a keloid resection increase the risk of graft failure?
The amount of radiation required to prevent keloid recurrence after excision is lower than what would be expected to compromise a skin graft. The studies cited are dealing with postoperative radiotherapy for cancer, where radiation doses are required to be higher than what is used for a keloid, and ...
Is there anything you use for patients with anticipatory nausea who has failed Ativan and Zyprexa?
I know of no data, but I would consider hypnosis, mediation and mindfulness, cognitive behavioral therapy, acupuncture, and medical marijuana as possible options for anticipatory nausea refractory to lorezapam and Zyprexa. Hypnosis, mindfulness, and cognitive behavioral therapy are in a sense are re...
Will patients who receive radiation to a large mediastinal nodal field have an increased susceptibility to COVID-19?
While the actual infection of COVID-19 has more to do with hygiene, social distancing, and prevention such as drugs or vaccines, the susceptibility for the patient to develop symptomatic progression of COVID-19, once infected, has a strong theoretical possibility. The factors that impact severe lymp...
Is there a correlation between rectal cancer stage and dose response to radiotherapy?
Possibly. While some compelling data from Appelt et al. in 2013 reflected there may be a correlation between RT dose and rectal tumor response (Appelt et al., PMID 22763027), an extensive number of prospective trials examining the influence of boost doses of RT on pathologic response have produced m...
How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?
I just had this discussion with our chief of interventional pulmonolgy at MD Anderson. Some of his faculty are being asked to staff our COVID-19 patient floor. In addition, bronchoscopy procedures should be considered high-risk procedures, and are required to have at least 45 minutes in between proc...
How should radiation oncology departments prepare for significant resource depletion and/or staff shortages with the COVID-19 outbreak?
Resource depletion to the extreme would be analogous to having a non-operational clinic as some experienced during the Hurricane María disaster. I would suggest reading the paper:Lessons Learned From Hurricane Maria in Puerto Rico: Practical Measures to Mitigate the Impact of a Catastrophic Natural ...
Would you consider offering salvage radiation to a patient with castrate resistant prostate cancer who has never had local therapy and has no evidence of lymph node or distant metastasis?
It's hard to give a great answer without knowing more information, such as the PSA, Gleason score, and T-stage at presentation, why he was treated with androgen deprivation alone up front, what AD he was treated with, how long he was under treatment before he became castrate resistant, and what is t...