Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer a patient with “good-risk” DCIS and an elevated DCISionRT score APBI or WBI?
Based on the technical suitability, either option is fine.
How do you manage a glioblastoma of the brainstem/upper cervical spinal cord?
It used to be that we didn’t get biopsies in this location, and we treated suspected astrocytic tumors in the brainstem/upper spinal cord to 54 Gy in 30 fractions without tissue. The outcome was never good. But now we generally have at least a stereotactic biopsy. The outcome is still not good of co...
Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?
From my experience, this is a catch-22. If you stop the Denosumab you will markedly increase osteoclastic activity throughout the entire skeleton which is why it is recommended that you not stop the medication without some other intervention. I have had several patients with either osteonecrosis of ...
How would you approach treatment of an optic nerve sheath meningioma presenting with complete ipsilateral visual loss?
Radiosurgery to prevent further tumor growth of an optic nerve sheath meningioma in a patient with complete ipsilateral visual loss can technically be accomplished. It is prudent to not include the chiasm nor the very proximal optic nerve due to Wilbrand's knee of the optic chiasm (where crossing fi...
What would you recommend for early stage vulvar cancer with close margins?
With negative sentinel LN's in an early stage patient, I would try to avoid the use of radiation if possible. Re-excision with a clear margin of 1-2 cm, extending to the deep perineal fascia, should be adequate to give a high rate of local control and cure, in the absence of other negative prognosti...
What is your preferred radiation technique for treatment of skin cancer of the eyelid?
Beam and internal eye shielding (between globe and eyelid)
How do you approach treatment of a craniopharyngioma in an older adult patient?
There is a bimodal age distribution, with one peak in children between 5 and 14 years old and the second peak in adults between 50 and 75 years of age. Adamantinomatous (frequently with calcification) craniopharyngiomas are more common in children, while papillary (frequently lack calcification) cra...
Is the phase 2 data regarding neoadjuvant cemiplimab in cutaneous squamous cell carcinoma sufficient to adopt for all patients or will you await phase 3 data?
The current data are quite compelling, but not sufficient to adopt for all patients. We need to see the long-term recurrence and survival rates from the phase II study and also perform a confirmatory phase III trial with a survival endpoint. Unless this treatment approach results in equivalent to im...
What criteria do you use for replanning with a new CT simulation for patients being treated definitively for head and neck cancer?
Whenever nodal shrinkage or weight loss reduces the fit of the mask we make a new mask in same position and re-calculate doses using existing IMRT beam and dose fluences. Tumor dose never reduces based on our experience, and the main issue are doses to organs. Skin dose may increase and it may be wo...
For which patients, if any, do you typically order additional imaging workup for staging in early-stage breast cancer?
Many studies have shown the true-positive rate of distant metastases on pretreatment imaging to be a few percent (at most) for patients with Clinical Anatomic Stage I-II cancers. The false-positive rate is much higher. Hence, such imaging should only be used when patients have suspicious symptoms or...