Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your top takeaways in Neuro Oncology from ASTRO 2024?
A Prospective, Phase II study of 177Lu-Dotatate in patients with surgery- and radiation-refractory meningioma: Results of the WHO grade II/III cohort, presented by Kenneth Merrell. I have spent a large portion of my career emphasizing optimal management for meningioma patients and this study opens ...
How do you approach deciding between SRS and fractionated radiation for an acoustic neuroma?
Offer fractionated RT if patient has serviceable hearing (can use the phone on that side). Otherwise SRS if less than 3 cm. If larger than 3 cm and not a surgical candidate, fractionated RT.
What is your approach to managing follicular lymphoma with central nervous system involvement?
Not really an expert on this issue. Fairly uncommon to have a follicular lymphoma-associated CNS disease. Our usual is for high-dose methotrexate, Temodar, and rituximab. Potentially followed by autologous stem cell transplant.
Would presence of DIEP flap reconstruction impact your decision to proceed with a BID approach to PMRT for inflammatory breast cancer?
The short answer is no. I would first carefully review the history that led to an IBC patient having immediate reconstruction since immediate reconstruction is not recommended and it warrants a careful review. Ideally, the patient would have upfront photos of skin involvement, bilateral nodal evalua...
For palliation of gastric bleeding due to malignancy, is a G-tube a contraindication for RT?
I would not change my approach because of a G-tube and I base my dose/fractionation largely on performance status. This recent systematic review is helpful and highlights that a low BED regimen is typically adequate for effective palliation (Tey et al., PMID 28445941).
Would you offer salvage radiation for biochemically recurrent prostate cancer with a transplanted pelvic kidney?
You may want to consider a PSMA PET/CT or Fluciclovine PET/CT if the PSA is >=0.2 at 0.2-0.5 about 30% of scans are positive, at 0.5 and up ~ 50% or more. If you had a target it may guide field design. I would also be curious about life expectancy of this patient, PSA doubling time, and time form or...
Is TURP a contraindication for prostate cancer SBRT?
I have not done it, but Georgetown experience recently published here: Pepin et al., PMID 32432033A recent informal Twitter poll shows many are comfortable with SBRT after TURBT: https://twitter.com/TylerSbrt/status/1323315130990432256?s=20I'm interested if any have further insight.
How do you approach a patient with cN0 breast cancer who has high risk features but did not have a sentinel node biopsy?
For T1 and T2 disease, I usually treat levels 1 and 2 in tangent beams.
How would you counsel a young female patient who refuses to use contraception during radiotherapy?
A woman who refuses contraception needs careful psychological and psychiatric assessment and considerable time at the time of consultation to understand why she is refusing, especially since this response is neither rational nor logical. The practitioner needs to take the time to discuss the patient...
Would you consider APBI in an otherwise-suitable patient who has ITC in a sentinel lymph node?
I would treat ITC like node negative and would treat with APBI if otherwise suitable.