Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Aside from radiation, what is your approach to patients with EGFR-mutated or ALK-translocated metastatic NSCLC who have systemic disease control but fail in the CNS?
While there are systemic agents that have brain penetration, my most standard treatment remains radiotherapy. That said, the questions specifically asked about non-XRT options. I do think about parenchymal brain metastases and LMD a bit differently. For LMD in EGFR-mutated NSCLC, I do sometimes use ...
Would you offer neoadjuvant radiation therapy with concurrent chemotherapy for a T4 rectal carcinoma with an associated rectovesical fistula?
In the past, some considered fistulas to be a contraindication for radiation therapy due to concerns about potential worsening. However, our understanding has evolved, particularly in cases where the tumor itself is often the primary cause or a significant contributor to the fistula. Consequently, i...
Do you recommend radioactive iodine for Hürthle Cell thyroid carcinoma?
I’m not a thyroid expert. @Dr. First Last or Roi Dagan are better versed on the topic. It’s fine to try RAI but it’s less likely to be effective compared with papillary.
In patients with multiple basal cell carcinoma lesions on vismodegib, would you hold vismodegib while delivering radiation therapy to one locally advanced BCC lesion that was not amenable to surgery?
I agree. Based on the recently published paper in JCO (Barker et al., PMID 38630954), vismodegib can be safely administered with radiation therapy for locally advanced BCC. RT + vismodegib yielded high rates of control and progression free survival.
What is your approach to counseling patients who require definitive radiation therapy to the head and neck but for whatever reason, cannot/will not undergo recommended extractions?
I am fortunate to work at a center where we have dentists and oral surgeons on-site. They carefully evaluate all our patients scheduled to undergo H&N RT, make recommendations, and perform the extractions. In the unusual scenario where the patient refuses recommended extractions, I proceed with trea...
How would you manage a Merkel cell carcinoma that spontaneously regressed clinically in a patient medically high-risk for surgical resection/anesthesia?
Less than 5% of MCCs are T0. I’ve never seen spontaneous regression of a biopsy-proven MCC in over 45 years. That said, should lightning strike, RT to the primary site and elective RT to the regional nodes.
How do you approach the management of basal cell carcinoma with single lymph node involvement?
If all the tumor has been resected, I would recommend adjuvant XRT on the nodal basin, depending on the age of the patient. For very old patients or patients with comorbidities, observation might be warranted. If there is remaining BCC visible on examination or scans, I would treat systemically with...
What is the best management for recurrent basal cell carcinoma after prior radiation and vismodegib?
Recurrent basal cell carcinoma can be challenging to manage. It is important recognize that vismodegib is FDA approved for basal cell carcinoma that is not treatable with surgery or radiation therapy. In this case, if you think radiotherapy could be given again, vismodegib should have never been us...
What is the best treatment for radiation recall skin reaction of the breast?
History and distribution suggest radiation recall effect. If no agent which precipitated recall, can be ascertained then have done symptomatic management with a topical agent and follow up to see course (it subsides or gets better with time).
Does postoperative radiation within 24 hours of a skin graft with a keloid resection increase the risk of graft failure?
The amount of radiation required to prevent keloid recurrence after excision is lower than what would be expected to compromise a skin graft. The studies cited are dealing with postoperative radiotherapy for cancer, where radiation doses are required to be higher than what is used for a keloid, and ...