Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is morphea, cutaneous scleroderma, with no organ involvement a contraindication for radiation in early stage breast cancer as part of breast conservation therapy?
I am not sure anyone can answer this question with a solid yes or no answer. The information we have about limited scleroderma and radiotherapy is for, lack of a better term, limited. We can draw from some experiences to guide the thought process. In one large series of patients from two scleroderm...
For inoperable cholangiocarcinoma, do you recommend up-front chemotherapy prior to offering SBRT or combination chemoradiation?
For inoperable cholangiocarcinoma, there are many factors to consider. First, does the patient have any metastatic disease? If no, then how large is the primary and are there any nodes? Finally, is the patient suffering from biliary obstruction - causing hyperbilirubinemia and persistent/recurrent c...
Do you utilize consolidative RT for oligometastatic HPV positive head/neck cancer with stable disease on immunotherapy?
This is a difficult question to answer since there is little if any data for guidance, and also the management of this issue is evolving with regards to the increasing impetus to treat oligometastatic disease aggressively, and the increasing use of immunotherapy in patients.This specific question al...
In the setting of unresectable Ewing's sarcoma in an adult, would you consider boosting to a higher dose?
I would not hesitate to dose escalate to 60-64Gy if indicated by other adverse risk factors. I think size, response, and medical condition of the patient are all important in determining if it is appropriate to dose escalate in Ewings. Local control for definitive radiation of vertebral body tumors ...
How would you approach SBRT in a pacemaker-dependent elderly patient with Stage I NSCLC whose SBRT plan Dmax exceeds the pacemaker tolerance?
For any patient who has a pacemaker, we always send them to be evaluated for the device by a cardiologist before simulation and after finishing all fractions of the SBRT. In addition, we check their vital signs daily after each fraction of SBRT. For SBRT planning, we will minimize irradiating the p...
What can prostate patients do for sexual function while on ADT?
While libido drops for most men on ADT, sexual function is still an important component for many, and educating on what to expect will help prevent disappointment or confusion. First, some men can get an erection with testosterone suppressed, but it is less common and not as firm an erection as wha...
Should prostate cancer genomic classifiers, such as Decipher, be used in all high risk post-prostatectomy patients to risk stratify patients to adjvant RT vs PSA observation and possible salvage RT?
I think that the data are hypothesis generating and can assist in physician decision making. Additional analysis from other independent cohorts substantiate the findings from the JCO paper whose publications will be forthcoming. It is important to discuss the findings, including the limitations, wit...
How do you approach treatment for patients with ALK+ mNSCLC who have multifocal or leptomeningeal CNS progression while on first-line targeted therapy?
Leptomeningeal disease is one of the more challenging scenarios to manage in a patient with ALK rearranged lung cancer. One must work carefully with the radiation oncologist and factor in imaging findings as well as patient symptomatology to make the best decision moving forward. Radiation options i...
Do you recommend omitting radiation therapy in young women with favorable DCIS?
If someone can get a screening mammogram, diagnostic mammogram, image-guided biopsy, segmental mastectomy, entertain a conversation about 5 years of ET, they can most certainly handle 5-15 days of PBI where the grade 0 toxicity rate is exceedingly high. Whole breast RT with the Whelan regimen is als...
In a clinically node negative early stage breast cancer patient who underwent neoadjuvant systemic therapy, would surgical finding of fibrosis suspicious for treatment effect in sentinel nodes impact your RT decision?
I would treat breast only for most of these patients with favorable early-stage disease. More so with B-51 not showing benefit even in clinical positive becoming negative.