Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does the possibility of future Lu-177–PSMA therapy change your current threshold to offer earlier metastasis-directed RT in oligometastatic prostate cancer?
There is a lot of excellent research being done on the efficacy and tolerance of combined Lu-177-PSMA therapy and EBRT. So far, the combination is well tolerated, and there is some data that sequencing the two to allow EBRT to treat the more “Pluvicto-resistant” lesions may help with efficacy.The qu...
How do you approach treatment of 1p19q non-codeleted high grade gliomas?
The question focuses on the management of 1p19q non-codeleted high-grade gliomas, which for all practical purposes translates roughly to the entity that by legacy terminology has been referred to as anaplastic astrocytoma. This question has come into focus with the recent publication of results of t...
Would you offer APBI in a patient with Paget's disease?
If breast MRI followed by central lumpectomy confirms DCIS with negative margins, then I would offer APBI with the same principle as used for DCIS.
Are there patients for whom CROSS followed by surgery and adjuvant nivolumab should still be considered, following data from MATTERHORN and ESOPEC?
ESOPEC does not invalidate CROSS—it redefines the preferred option for fit patients; in the real world, not every patient will be able to tolerate FLOT or d-FLOT: Yes. Despite the emergence of perioperative FLOT-based strategies from ESOPEC and MATTERHORN, CROSS, followed by surgery and adjuvant niv...
What are the indications to treat Dupuytren's disease with radiation?
I would not offer any radiation therapy after a surgical procedure for Dupuytren's contracture. Should the patient develop recurrent nodules that progress more than 6 months following surgery, then I would consider definitive split-course electron beam therapy to deliver 30 Gy at 3 Gy per fraction w...
How many days do you hold osimertinib during or around SBRT for oligometastatic EGFR mutated advanced lung cancer?
This a great question and a common clinical scenario that we are all confronted with. Stereotactic body radiation therapy (SBRT) is being increasingly used for oligometastatic progression of EGFR mutant NSCLC. The theoretical risk of combining EGFR inhibitors and radiation therapy would be an enhanc...
Do you wait to treat small asymptomatic brain metastases until they reach a certain size?
I typically treat all lesions on MRI that are found to be concerning for brain metastases. This is after a discussion with our neuroradiologist colleagues. If there is uncertainty that a small lesion may not be a brain metastasis, then I will elect to follow with a surveillance MRI and treat in the ...
How are the long term results of RTOG 9802 being incorporated into practice in the treatment of "high risk" low grade gliomas?
Answer was written along with Cleveland Clinic resident, Ehsan Balagamwala, MDThe decision to treat low grade gliomas (LGG) can be very challenging. At our institution, we typically utilize the EORTC risk factors to stratify our patients. EORTC high risk is defined as having 3 or more of the followi...
Are you covering the tracheostomy site with a surgical mask due to COVID-19 to protect the therapist?
I have not routinely used masks over tracheostomy tubes, but it seems like a good idea in the current environment. Our staff, including physicians, nurses, and therapists, do use masks while taking care of these patients, including during suctioning of tracheal secretions.
Is there an absolute PSA level above which you would not recommend a radical prostatectomy for newly diagnosed prostate cancer despite the absence of metastatic disease with advanced imaging?
There is no absolute PSA level that would preclude radical prostatectomy in the absence of metastasis on staging imaging. However, I would explain to the patient that the chance of occult metastatic disease and the need for additional treatment after prostatectomy increases as the PSA increases. I w...