Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are weekly port films or daily cone beams considered standard of care for 3D breast treatment?
It doesn't have to be either/or. But...As Don Rumsfeld said, "You go to war with the army you have, not the army you want." Some practices, and they are rare admittedly (think: a site with only a Tomotherapy machine) can't really do "port films" per se and they're wont to do daily IGRT/CBCT. If "MRI...
How would you treat a basal cell carcinoma on the temporal skin and zygomatic area s/p excision with PNI and significant flaps for closure?
This case is a challenge as it is not clear what the indication for PORT is. Margin status is important, so discuss with the surgeon, and if positive, can a repeat resection occur, likely not given the presence of the flaps, however. The guidelines from 2019 are a neat and logical review that establ...
For esophageal cancer treated with primary chemoradiotherapy, with residual disease on 3 months PET, would you repeat a PET at 6 months?
It depends on what the doc and the patient will do with the information. If the patient received primary chemo rads because they were not a surgical candidate initially, they would not be a surgical candidate after treatment. Thus, if there is a recurrence, any subsequent treatment would be palliati...
What are your top takeaways from SGO 2024?
SGO 2024 was a great meeting with many excellent presentations. We are truly “moving the needle together”. The following presentations are each practice changing. Duska et al., PMID 38521086: Pembrolizumab plus chemoradiotherapy for high-risk locally advanced cervical cancer: randomized, double-bli...
Would you offer lung SBRT for an individual with rheumatoid arthritis?
I wouldn't hesitate to use SBRT in this setting, all things being equal. The important caveats for "equal" are whether they have any component of interstitial lung disease. I'm very fortunate to have access to proton therapy, and about the only time I use it for SBRT lung is in patients with severe ...
Is chronic methotrexate for rheumatoid arthritis a contraindication for prostate brachytherapy?
I would agree with Dr Rogers that there is really limited information with in the published literature to guide us in this specific clinical situation. In my personal experience I have recommended holding the methotrexate (if possible) prior to a planned course of external beam radiotherapy, HDR bra...
Should methotrexate be stopped prior to radiation therapy if a patient has rheumatoid arthritis?
I have not stopped as dose of MTX for RA is low (7.5 mg) and there is data of CMF with RT for breast cancer with higher dose of MTX showing no significant increase in morbidity.
How would you manage a cardiac metastasis from Merkel cell carcinoma?
I would first determine the extent of metastases and carefully determine the extent of the tumor in the heart (usually with cardiac MRI). I would also discuss the threat of the tumor to the heart with a cardiologist (if possible). If extensive metastases were present, I would suggest starting with i...
Is there any increased risk with adjuvant breast radiation for a patient with muscular dystrophy?
I don’t see any contradiction with dystrophy.
Do you still order mpMRI for staging of prostate cancer in addition to PET-PSMA?
Yes, I still think the prostate MRI adds valuable information for target delineation and local staging. This position is consistent with a recent poll of GU specialists where about 90% of respondents believed that a prostate MRI was still necessary after a PET/CT (Gillessen et al., PMID 35450732).My...