Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you routinely treat oligoprogressive metastatic sites with SBRT in patients receiving systemic therapy and otherwise stable disease?
I am often referred patients who have oligoprogressive disease in the context of widely metastatic disease that is responding to systemic therapy, particularly targeted therapies. These patients have often been on these therapies for at least a year and generally have good performance status. The de...
In asymptomatic patients with unfavorable intermediate risk prostate cancer and a PSA <10, how helpful/reliable and clinically useful is bone imaging?
Bone scans amazingly are still something we discuss, and I imagine when we look back in 5 years at this question (at least I hope), people would think it is unthinkable to order a bone scan for intermediate risk with PSA <10 (let alone in localized PCa) instead of MRI and/or PSMA PET/CT.10 years ago...
How will the PROSPECT trial presented at ASCO 2023 change your current management of early rectal cancer?
I can’t overstate how much credit the Principal Investigator, Dr. @Dr. First Last, deserves for successfully completing the PROSPECT trial. The oncology community, particularly the radiation oncology community, was concerned that omitting radiation would put patients at risk. It was difficult and ch...
What radiation dose constraints should be used for the spinal cord in pediatrics?
As part of the PENTEC project (Constine et al., PMID 37999712), I had the privilege of finding all of the cases of pediatric radiation myelitis in the literature. This is modified from our published findings, I encourage you to read the full manuscript if you would like further details (Cooper et al...
For anal radiation dermatitis, does anyone have experience with 3M Cavilon protectant?
I've used it a couple of times. It is most useful for those with a lot of discharge, incontinence, and chronic moisture. In those patients treating early with an antifungal agent and using barrier protection cream like cavilon can be helpful. That said, it is not clear to me that Cavilon is better t...
Can patients receive adjuvant radiation therapy after keloid excision without primary closure, or would radiation impede healing by secondary intention?
I have personally treated several patients where primary closure was not obtained due to the large size of the keloid (back and anterior mid-chest). Due to the limitation of raising a large flap around these regions to close the wound primarily and poor take rates of a skin flap, these resections we...
For meningiomas causing symptoms such as headaches, what percentage of patients experience improvement of symptoms after radiation alone?
Without question, patients are often found to have meningioma after presenting with headache. At times the headache may have been due to meningioma, particularly if the meningioma is large meningioma, has broad-based dural involvement, and/or is accompanied by edema, which they often are, especially...
How many missed fractions will you allow for a definitive lung CRT before recommending treatment on the weekend?
The clinical scenario posted in this question is not rare, since patient compliance or machine issues could result in missing fractions (i.e. treatment break) as originally planned & scheduled in a conventionally fractionated radiotherapy course (including definitive lung CRT that typically aims to ...
How would you treat a synchronous oropharyngeal cancer and proximal esophageal cancer?
After Dr. @Dr. First Last has set the tone for definitive chemo-RT that I totally agree, I would like to offer some additional thoughts: It is assumed that both synchronous primaries are anatomically separate and have been proven histologically distinct; e.g. the oropharyngeal primary being a SqCC ...
Is positive pleural fluid cytology from pleural mesothelioma considered M+?
No, positive pleural fluid cytology is not considered M1 disease based on AJCC 8th edition staging. Pleural effusion with positive cytology is often present even in early stage disease.Initially, MPM forms small, discrete nodules on the parietal pleura surfaces, convalescing into confluent sheets of...