Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you ever consider intermittent ADT for metastatic prostate cancer?
In general, I recommend continuous ADT for men with metastatic disease based on the OS difference from the Intergroup 0162 trial. I do agree, however, that this trial was a noninferiority design and the difference is not large, therefore in men with very limited disease who display intolerance to AD...
In what situations, if any, would you add chemotherapy to adjuvant radiotherapy in patients with resected head and neck cancer without ENE or positive magrin?
I would only consider adding Chemotherapy to radiation if at least 3 intermediate risk factors (as mentioned in the question) are present post-operatively in an HPV negative patient. Obviously, each such patient is discussed in the tumor board prior to such recommendation.
Why are patients getting enzalutamide s/p prostatectomy not candidates for salvage radiation therapy?
Although there have been other efforts to profile the role of enzalutamide (e.g., SALV-ENZA, Tran et al., PMID 36367998) or other second generation androgen axis inhibitors (e.g., FORMULA-509) in conjunction with salvage RT, EMBARK (Freedland et al., PMID 38320501) was designed to test the efficacy ...
Would you offer adjuvant XRT to the prostate fossa in a patient with Lynch Syndrome?
The question at hand appears to primarily be asking the safety of using ionizing RT in patients with Lynch syndrome. The second component of the question, which changes my answer potentially, is would one use adjuvant RT post-prostatectomy for patients with prostate cancer? Point 1: Safety of RT in ...
In post-prostatectomy patients where urinary continence is never achieved, how and when would you plan RT when it is clinically indicated?
I have seen this occur. Generally, I'll discuss it with the patient's urologist to get a sense of how they're planning to manage the incontinence. If they're planning an artificial sphincter, I'll generally wait until that procedure is done. If they're just planning to manage it medically, once it's...
Do you consider treatment of the supraclavicular region mandatory for breast cancer patients with a chest wall recurrence?
In our practice at MD Anderson, we routinely treat the chest wall and undissected nodal basins in patients with chest wall recurrences who have not had prior radiation. As most of these patients have undergone prior axillary surgery, it is plausible that they will have aberrant lymphatic drainage. T...
How would you approach therapy for a solitary fibrous tumor of the orbit with residual disease (10%) after surgery?
The discussion about the possibility of complete resection, even if it involves orbital exenteration needs to happen since that is the only potentially curative treatment. If surgery is not an option or if it is deemed unacceptable by the patient, SFT is indeed radiosensitive. The discussion of the ...
How would you approach cT3N0M0 squamous cell carcinoma of the supraglottic larynx in a patient with a history of breast cancer and prior radiation to the supraclavicular fossa?
I would try and get the prior radiation treatment plan to ensure that the supraclavicular fossa was adequately treated and to determine exactly how high up the fields went and attempt to match elective nodal coverage to about that level. In the absence of the prior radiation information, I would lik...
What whole brain radiation dose would you recommend for primary CNS lymphoma with partial response to HD-MTX-R and R-ICE and planned for concurrent ibrutinib?
There are many uncertainties in how to optimal treat patients with PCNSL. It is clear that high-dose MTX-based regimens should be pursued when feasible. The role, if any, of RT is controversial. If pursued, a WBRT-based approach is generally considered most appropriate.With that said, if a patient o...
How do you approach post-operative SRS for melanoma metastases in the setting of immunotherapy?
I always offer postop SRS or HSRT as after surgery, the blood supply of the area will be compromised affecting drug delivery.