Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel patients and partners of patients with HPV+ cancers regarding the HPV vaccine?
The patient was likely exposed in their teens or twenties. The partner is likely too old to be vaccinated. Independent of the cancer, children should be vaccinated.
Has the recent presentation of RADICALS-HD changed your ADT duration recommendations for patients receiving post operative radiation therapy for prostate cancer after radical prostatectomy?
The way I interpret RADICALS is that for adverse pathology meaning GS 8 and above, T3 disease or node positive who benefit from ADT would favor 24 over 6 months and probably these are patients who benefit from nodal RT also. For a favorable type prostate fossa only RT with unclear if any additional ...
What percentage of your patients receive hydrogel SpaceOAR?
T3+ or poor KPS, we don't use SpaceOAR.
Do you ever consider small vessel doses when determining your dose for SBRT?
We do not constraint dose to the azygous vein, or other small vessels when giving SBRT. We similarly do not constrain dose to large vessels such as the IVC or the Aorta either, and I am un-aware of specific reports of toxicity to these structures. Structures that I am particularly concerned about ar...
Should combined brachytherapy/EBRT/ADT be the standard of care for men with high-risk prostate cancer?
The results of the ASCENDE-RT trial are obviously very encouraging and corroborate findings from single institution studies that combined brachytherapy and external beam radiotherapy in conjunction with hormonal therapy is associated with superior outcomes compared to dose escalated external beam ra...
When is the earliest you would consider starting radiation after total laryngectomy?
I’ll first try to answer the question of a suitable time interval between radical surgery and the initiation of post-operative radiotherapy (PORT) for advanced H&N cancer in 3 ways: For those who only want treatment “guidelines”: NCCN states explicitly that the preferred interval between resection a...
What is the appropriate dose for palliation of bulky prostate cancer?
As always with palliation, the devil is in the details. How bad is the disease, what is the patient's performance status,... Having said that; very little literature is out there, but one prospective study explored doses from 30-39Gy in 3Gy fractions and found good palliation and low toxicity. There...
Would you recommend adjuvant radiation therapy to the locoregional lymph node basins for Merkel cell carcinoma (MCC) with a solitary macroscopically positive lymph node (LN) without ECE after lymph node dissection?
As always the need to prophylacticaly treat possible residual nodal disease is influenced by many factors. Histology a key factor. Merkle cell is usually one step ahead of treatment. In this case I would definitely treat the nodes at risk. I would also treat widely around the resected primary skin s...
What is your approach to adjuvant treatment to the tumor bed and/or regional lymph nodes for an early stage Merkel cell carcinoma status-post WLE and sentinel lymph node biopsy?
Merkel cell carcinoma is almost always beyond what you think are the safe margins of resection. Regardless of the completeness of wide local excision I generally extend the postoperative field two or 3 cm beyond the theoretically clear margin, obviously staying off of critical structures such as the...
What is the radiation volume for M+ pure germinoma with brain only extra-ventricular mets and negative CSF/spine imaging?
In general, I wouldn't recommend chemo for M+ Germinoma kids because it does not favorably improve the therapeutic ratio based on the findings from GCT96 (NCT00293358).Independent of chemo, 24 Gy CSI with a boost to 36-40Gy is sufficient for cure. With chemo, 21 Gy CSI & an involved field boost to 3...