Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you consider using ALK targeted systemic therapy in lieu of WBRT or SRS for patients with metastatic ALK-positive NSCLC?
The development of crizotinib in ALK positive patients led to incredible control rates systemically, but as is now well known, less ability to control CNS disease. When crizotinib was the sole FDA approved ALK directed therapy, this led to the concept of "treatment beyond progression" such that pati...
What is the evidence that there is a benefit to giving doses higher than 3060 cGy-3600 cGy in the elective treatment of uninvolved lymph nodes in the treatment of SCC of anal canal with chemoradiation?
The published data with dose varying from 30.6 to 45 Gy to uninvolved nodes has not shown any difference in regional control. The studies which did not treat the pelvis to an adequate volume or excluded inguinal region reported higher regional recurrence.
What goes into your decision making when deciding between superficial radiation and Mohs surgery for cutaneous squamous cell carcinoma of the head and neck?
When it comes down to deciding between surgical resection and definitive radiotherapy for well-differentiated, non-melanomatous skin malignancies, my simple rule of thumb is: While surgery may be the gold standard, whenever the post-operative cosmetic or functional sequelae are perceived to be poten...
How are you utilizing vibratory devices for reducing pain associated with injection or procedures?
Specifically for intra-articular/bursal/tenosynovial/carpal tunnel injections: Our office purchased the vibration distraction devices over a decade ago based upon the promising use from the pediatric literature. Our providers were underwhelmed with their use in our adult patients and we all stopped ...
Would you include the entire hardware as part of ISRT for a patient with Stage IE DLBCL of the distal femur treated with upfront prophylactic nailing for impending fracture, who had a CR to chemotherapy?
Quite uncommon to encounter such a patient, but based on data for non hematologic tumors, no. Treat just the involved site with a generous margin, the latter never precisely defined, but depends on the tolerance of surrounding normal tissue. Parenthetically, it's often difficult to determine a CR to...
Is it appropriate to offer combination lung SBRT and immunotherapy for oligometastatic melanoma outside of a clinical trial?
What is the anticipated recovery of bone marrow hematopoiesis after palliative radiation therapy?
What dose and fractionation do you use to palliate mycosis fungoides lesions?
I will admit that I utilize a wide range of fractionation schedules, depending on the clinical circumstances when treating mycosis fungoides. The data suggests that 2 Gy x2 is not an effective palliative schedule, with a CR rate of only ~30% with almost all lesions requiring re-treatment (Neelis et ...
Would you offer dose reduction to 36 Gy pre-op to a lower extremity low grade myxoid liposarcoma based on results of the DOREMY non-randomized data?
This is a great question. In consultation, I start discussing standard preoperative RT over 5 weeks, but then review the nuances of myxoid liposarcomas (e.g., radiosensitivity). We had a thoughtful discussion about the DOREMY study, including the de-intensification radiotherapy approach, results, an...
Which targeted systemic agents should be held while delivering palliative radiation?
Great question regarding the use of systemic therapy for cancer during palliative radiation. First, regarding targeted therapies, there are no reports of targeted therapies which would be unsafe or should be held during palliative radiotherapy. Most targeted agents are monoclonal antibodies to recep...