Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What doses and volumes do you use in treatment of rectal cancer post-operatively?
A surgeon I once worked with used to say "Post-op RT is a disease". I can't remember the last time I treated someone with rectal ca post-op. When we recommend surgery first without pre-op, it is with the understanding, that will not be don't post-op regardless of the pathology. However, here are so...
How do you manage high grade dysplasia of true vocal cord a yr after radiation to the larynx for T1 lesion?
Transoral excision.
What approach do you use when treating adult diffuse gliomas with H3-G34 mutations, now classified into their own category under the 2021 glioma guidelines?
Although DHG H3G34-mutant diffuse gliomas are more commonly associated with pediatric patients, they can occur in young adults as well. In a recent paper describing 17 patients harboring this rare mutation, the median age at diagnosis was 25 years (range: 19–33). All tumors were hemispheric. All cas...
Would you offer consolidative scrotal RT for patients with bilateral testicular lymphoma involvement s/p bilateral orchiectomy and chemotherapy?
I assume you are referring to bilateral scrotal involvement by DLBCL. The initial stage of the disease is also not clear. If both testes have been removed, the risk of involvement with the scrotal sac may be assumed low. However, I would take a good look at the pathology report concerning extratesti...
How would you approach treatment of a patient with adenocarcinoma of unknown primary only found in a left supraclavicular lymph node?
Systemic therapy. Palliative RT if necessary
How do you approach stereotactic radiosurgery for acoustic neuroma in patients who are awaiting cochlear implant?
Defer to the otologist. You could SRS before or after unless the otologist has a strong preference. As long as the cochlear implant is MR-compatible.
Which patients with cSCC could you omit adjuvant radiation following pathologic complete response following cemiplimab?
I think we need to distinguish between pCR as assessed by a random biopsy versus a complete resection of the involved primary site - the latter is rarely performed since the premise for giving cemiplimab in the first place would have been to avoid a morbid surgery. pCR is not always easy to assess f...
Do you recommend probiotics to patients receiving pelvic radiotherapy?
I have not routinely recommended a probiotic to patients receiving abdominal or pelvic radiation but I did learn early on in my career to suggest it if they continued to have symptoms beyond the usual 2 weeks following radiation and found that it often helped a great deal. I have no idea which is th...
Would you recommend adjuvant capecitabine and radiation in addition to adjuvant FOLFOX for a patient with resected pT3N2 rectosigmoid adenocarcinoma with other high-risk pathologic features?
As with all rectal tumors, those that are labeled as "rectosigmoid" should be reviewed in a multidisciplinary tumor board at a center with deep sub-specialty expertise. In general, radiation is provided for rectal cancers--unlike for colon cancers--because of the increased risk of local recurrence a...
Would you irradiate the elective pelvis of a patient with high risk prostate cancer in the setting of osteoporosis and sacral insufficiency fractures?
Yes, I would irradiate the pelvis in a patient with high risk prostate cancer for whom elective pelvic nodal irradiation is indicated, even in the setting of osteoporosis and prior sacral insufficiency fractures. The bigger risk to bone health in these patients is the need for ADT, rather than pelvi...