Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there any role for palliative radiation in patients who are intubated due to malignant airway obstruction?
The literature is limited, but this small series showed about 1/4 of patients can have reversal of intubation.If the patient/family is interested in attempting, it occasionally works, but my own experience is less successful than 1/4. It is unlikely to worsen the situation, so after explaining that ...
Is there a time frame between surgery and radiation, after which, the benefit of adjuvant radiation is lost and no longer indicated for head and neck cancers?
Unfortunately, there are some patients that have post-operative delays. I don't know that the value of adjuvant RT "is lost" beyond 6-8 weeks, but we know the oncologic outcome can be worse. I would consider getting a high quality reassessment imaging either with CT, MRI and/or PET/CT of head and ne...
What would be your approach in a patient who presented with a solitary brain metastasis that resolved after chemo without local therapy?
While I have not had this happen with my patients receiving chemotherapy alone, in the era of targeted therapies for oncogenic driver mutated NSCLC, we have had some great intracranial response rates with systemic alone, and for these, I have held off SRS to evaluate response. In someone with a comp...
Would you recommend cardiac radiotherapy for malignant pericardial effusion refractory to pericardial fenestration?
Yes. I have done this several times and have gotten some reasonable palliative responses. Typically one cannot determine the exact source for the malignant cells, and one presumes that there are tumor deposits throughout the pericardium, in which case the target is the whole heart. This then limits ...
Would you ever offer definitive XRT in a patient with an elevated PSA (assume over 30) but who refuses prostate biopsy?
Absolutely not! There are too many benign processes that can cause an elevated PSA. Furthermore, patient-specific treatment options would differ based upon pathology. Gleason scoring is a primary driver for categorizing AJCC and other risk classification schemes. Genomic classification also requires...
To what dose do you treat the seminal vesicles in intermediate and high risk prostate cancer?
For men with unfavorable intermediate or high risk prostate cancer and T1c-2 disease, treatment of the SV's is recommended (following what you would do for local control if you had a RP - i.e. complete removal of the SV's) to a total dose of at least 70.2 Gy but rectum permitting (i.e. Rectal V70 < ...
Can you omit the vulva from the radiation field in isolated LN recurrence several years after initial vulvectomy/nodal dissection without adjuvant RT?
In my opinion, yes, assuming the patient has had a recent well-done pelvic examination with close inspection of the vulva and vagina. A more difficult question, I think, is whether to treat the ipsilateral pelvic LN's. In general I would favor treating ipsilateral pelvic LN's to microscopic disease ...
For primary angiosarcoma of the breast following mastectomy, what would your targets be for adjuvant radiation therapy?
For primary angiosarcomas, I typically treat chest wall only as long as no clinically involved nodes. Will go to 60 Gy postop with bolus if margin is negative.
Is it reasonable to extrapolate data from Glioblastoma and discuss Tumor Treating Fields in patients with Grade 4, IDH Mutant, astrocytomas?
While more than 90% of Grade 4 gliomas are IDH wildtype tumors (GBMs), this question does come up occasionally. Since I have no personal experience with TTF, I asked my collaborator Chirag Patel, MD, a neuro-oncologist at MDACC who regularly uses TTF in his patients, to provide his opinion. So pleas...
How do you approach isolated CNS recurrence in previously treated neuroblastoma?
As with other pediatric cancers, the CNS can be a sanctuary site for relapse given the poor CNS penetration of many conventional therapeutics used in the front line setting. As such, there has been an increasing frequency of CNS failures which can occur as early as a year to as late as 5-10 years in...