Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When, if ever, would you trace the facial nerve back to the base of skull for a pleomorphic adenoma of the parotid?
I would not chase on a routine basis. If path read peri neural invasion and MRI were positive, I’d chase electively. But one should get path reviewed in these situations.
Are there any specific high risk features or situations for which you would offer adjuvant radiation to a newly diagnosed benign pleomorphic adenomas following resection?
In the non recurrent (upfront) setting, it is not popular to jump to post op RT. The main rationale for using RT in a relatively benign disease is if there is a high probability of recurrence based on certain characteristics such as intra operative spill, unresectable gross residual disease etc AND ...
What features or presentations would prompt you to offer radiotherapy for paraganglioma vs. continued surveillance?
I think aside from symptomatic disease, other criteria I would consider for treating vs surveillance for paraganglioma include size/location where tumor growth in a particular location may lead to progressive/permanent neuropathies and therefore prophylactic RT may be warranted. I am also more likel...
When do you prefer to use bolus for treating superficial tumors adjacent to or involving the skin surface, especially for complex surface anatomy in the pelvis, head/neck, and extremity regions?
There is not a single answer to this question, as it depends on the specifics of the geometry, treatment technique (photons vs. electrons, beam angles, energy used, etc.), depth and size of the tumor, and other technical factors. Since almost no one has access to superficial or orthovoltage X-rays w...
What is the appropriate timing of CRT after TURBT for bladder preservation in the treatment of bladder cancer?
Our typical timeframe is 3-6 weeks. If it has been >8 weeks, we would recommend at least an office cystoscopy to confirm no gross residual/recurrent disease. We typically perform 2 TURBTs (one from referring and one at our institution) prior to CRT.
Would you offer partial breast irradiation to women who have HER2+ disease?
I agree with others that in the era of effective anti-HER2 systemic agents, the likelihood of in-breast recurrence can be very low for HER2 positive breast cancer patients undergoing breast conserving therapy. On the other hand, there is little to no prospective data regarding the efficacy of APBI. ...
How does your management of locally advanced NSCLC change in a patient with a previous contralateral pneumonectomy?
I've tried to tackle this a few times in my practice and it's uber hard. Depending on the size, it's often impossible. You are really stuck with the constraints for Mesothelioma in the setting of EPP. That is V20 of 7% and MLD of 8.5 Gy (Int. J. Radiation Oncology Biol. Phys., Vol. 69, No. 2, pp. 35...
In high risk prostate cancer treated with RT with neoadjuvant/concurrent ADT, is adjuvant intermittent ADT reasonable instead of continuous ADT?
As an option in general, I say no. Given multiple phase III trials showing an overall survival benefit of adjuvant ADT, I would need a robust non-inferiority study of intermittent ADT to recommend it. If a patient refuses or cannot tolerate continuous ADT but can tolerate intermittent, this is proba...
When administering adjuvant RT to the prostate bed with concurrent ADT, do you start concurrently or prefer to administer the ADT first?
In the absence of evidence I turn to first principles. If the ADT were short-term and aimed towards improving local control, then I would start the ADT a good few months ahead of the radiation to maximize the synergy. However, if it was a high-risk case with ADT planned for a few years and the radia...
Do you hold ADT before work up for prostate cancer when ordering advanced imaging such as PSMA PET?
The answer to this question is somewhat context dependent. The influence of ADT on a PSMA PET/CT is likely dependent on the clinical setting in which PSMA imaging is being considered, the duration of ADT prior to imaging, and how a provider plans to use the information to influence his or her treatm...