Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
How do you handle bladder filling for treatment planning MRIs for prostate cancer?
We use T2 cube sequence for MRI. When done for RT planning, it takes 5 to 7 minutes for acquisition.
Is axitinib with concurrent spinal RT safe?
We have always been cautious about giving axitinib concurrently with CNS radiotherapy. There is pre clinical data suggesting radiosensitization with high dose single fraction radiation due to VEGF effects on the endothelium (Rao et a., PMID 24794795.) Out of an abundance of caution, we typically sto...
What is your approach to treating gliomatosis cerebri?
I think a number of considerations have to be taken into account: - Symptoms, KPS, patient age, prior therapy, and underlying morbidities... At present, there are no clear biologic prognostic factors and so clarifying whether the cases represent true gliomatosis is essential. A recent consensus conf...
Does the presence of multifocal disease impact your decision on whether or not to recommend post-mastectomy radiation?
Yes, it does however multifocality is just one of several risk factors that predict for the likelihood of local recurrence and it is far less important than % nodal positivity, tumor size, age, +margin, multicentricity or adequacy of lymph node dissection. By itself, the presence of multifocality i...