Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For a patient with intracranial mets for ES-SCLC who undergoes resection, do you routinely offer post-op SRS to the cavity, or do you proceed with WBRT?
While Whole Brain Radiation Therapy (WBRT) has been the standard, stereotactic radiosurgery (SRS) to the surgical cavity is increasingly being used to minimize neurocognitive decline. However, the issue is especially more nuanced for an ES-SCLC (we don't know whether the primary has been controlled ...
How would you approach early stage NSCLC in a patient who is not an ideal surgical candidate and has pulmonary AVMs?
The standard volumes and flows of PFTs do not assess regional differences in what is perfused and ventilated. V/Q scans do, but their most common use for pulmonary embolism is their most common role. This serves to identify gas exchange near the primary as well as where the AVM’s reside. Target the ...
How does a negative PSMA PET change your management when completing salvage radiation for prostate cancer?
It's important to remember that if patients are being referred early for salvage RT, most of them will have negative PSMA PET/CTs (< 50% are positive if the PSA is < 0.5). So, in these cases, you are relying on the usual factors to decide on treatment fields, dosing, and the use of ADT, including ot...
Would you offer adjuvant radiation to a large solitary fibrous tumor of the lung s/p wedge resection with close margins?
If a benign SFT, I'd observe. If malignant, I'd consider 50 Gy/25 fractions to the surgical bed. The role of adjuvant radiation isn't well established, with some small reports suggesting LC benefit with tumors >5 cm and/or positive margins. Given "large" and more limited surgical resection with wedg...
How do you contour proximal SV for definitive prostate EBRT?
Few people may know where the idea of the proximal seminal vesicle CTV came from. After the RTOG had completed it's 9406 phase II dose-escalation study with 3DCRT, we began the 0126 phase III trial of 70.2Gy vs 79.2Gy with 3DCRT. For the intermediate-risk patients, the predecessor 9406 study had a c...
Do you get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...
Would you offer radiation therapy to a NF-1 patient with a painful and unresectable neurofibroma of the head and neck?
I assume this is a plexiform neurofibroma and its nerve related pain along the upper T or C-spine nerve roots?I would avoid radiotherapy if possible and instead work with your oncologist to evaluate whether the patient is a candidate for something like selumetinib if the lesion is progressive as the...
Is it safe to re-irradiate non-spine bone metastases with SBRT if they received previous SBRT?
This is a difficult question to answer. I would say "it depends." I would tread carefully with repeat SBRT for non-spine bone metastases in the following situations: 1. Mets that involve long bones/weight-bearing bones. Would ask ortho for an evaluation of the risk of fracture in weight-bearing bone...
In the treatment of osteoarthritis with low-dose radiation therapy is there data to support the claim that LDRT does not limit or preclude later orthopedic surgery?
At LDRT doses, the biological effects are anti-inflammatory and immunomodulatory rather than cytotoxic or fibrogenic, and there is no evidence of vascular injury, impaired cellular proliferation, or tissue destruction. Animal models and cellular studies provide robust evidence that LDRT at OA releva...
Is there an age cut off below you would not treat a keloid with radiation post surgical excision?
While radiotherapy is considered an extremely useful modality in the treatment of recurrent keloids in the adult population, most would contend that the risks do not justify the application of adjuvant radiotherapy in the pediatric population (PMID: 10703484) for a benign condition when other modali...