Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer definitive chemoRT for bladder cancer in a patient who had previously received prostate radiation?
It has to be individualized based on location in the bladder. Bladder neck may be harder with significant overlap from previous RT field but other locations can be done with reduced volume and avoiding including prostatic urethra in volume
What changes do you make in the management of non-endemic nasopharynx cancer compared to endemic?
a) There are 3 varieties of NPC; EBER +ve, HPV +, and non-viral There is only decent data for Induction (IC) for EBER +ve for a small survival benefit with cis-gem, and the group's follow-up suggested that pre-treatment DNA titers only showed benefit for those with high titers. I am not a HN med onc...
Does the presence of a connective tissue disorder such as lupus or scleroderma modify your radiation dose or technique for prostate cancer?
Here another article that may be of interest. It's actually a hometown favorite at VCU since the lead author is on our faculty. J Clin Oncol. 1997 Jul;15(7):2728-35.Irradiation in the setting of collagen vascular disease: acute and late complications. Morris MM1, Powell SN. PURPOSE: Based on repor...
What is your approach to management of radiation-induced bullous pemphigoid?
Bullous Pemphigoid (BP) is a pruritic autoimmune blistering disease characterized by tense bullae that is rarely caused by radiotherapy. There have been >30 reports in the literature related to RT with most being localized to the radiated location, with rare reports of BP at non-irradiated sites or ...
How would you approach the treatment of a single vertebral body involved with multiple myeloma (MM)?
If single level of involvement and no other bony disease (i.e. plasmacytoma of the spine), I would favor standard fractionation to 45-50 Gy as definitive treatment. I usually treat 50 Gy/25 fractions. If myeloma with other areas of disease, I favor standard palliative RT and cover 1 vertebral body a...
When do you refer patients for TURP prior to prostate radiotherapy?
Good question - my experience for both brachy and EBRT prostate cancer patients - has been the clinical narrative. That is - for patients with significant LUTS - who are already on alpha blockade prior to RT, and who are still having issues of urine flow - is to see if there is a mechanical reason -...
What special considerations do you take when treating cancer patients with severe intellectual disabilities?
Caring for patients with any type of disability is both a privilege and a challenge. Severe intellectual disability poses additional challenges due to logistical, ethical, and moral dilemmas. Additional factors including patients' socioeconomic status, support system, language spoken to individuals ...
What is your management strategy for patients with positive lymph nodes after radical prostatectomy?
There is a good retrospective study from Milan that shows considerable benefit to postoperative radiation therapy for node postive patients. DaPozza et al published this in "European Urology 55 (2009) 1003–1011". Their conclusions state: "Our data showed excellent long-term outcome for node-positi...
Would you offer palliative radiation to a patient with hematuria from squamous metaplasia of the bladder that is not responding to endoscopic therapy?
No.
What, if any, resources exist with recommendations regarding the timing and toxicity of radiation in patients who have received or are currently on immunotherapy?
Concurrent immunotherapy (PD1/PDL1) with chemoradiation is now not advised, given the two negative lung cancer trials (PACIFIC 2, CheckMate 73L). Concurrent immunotherapy with radiation alone is still an interesting area to explore, as the two published studies (SPRINT, Ohri et al., PMID 37988638, a...