Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer partial breast radiation in the absence of surgical clips?
Yes, as able to define surgical bed/seroma with a CT scan. If oncoplastic closure then there is no seroma/surgical bed to define without clips.
How are you approaching patients who receive neoadjuvant chemo immunotherapy for resectable NSCLC who after completion of neoadjuvant treatment are no longer surgical candidates due to factors such as toxicity, decline in PS, or patient preference?
This scenario seems to happen in 17-20% of patients. It’s very important to appropriately stage patients at diagnosis with PET CT, EBUS, etc to ensure accurate staging without which a good discussion regarding resectability is not possible. If a patient does, in spite of our due diligence, end up no...
How would you manage patients with exposed bone due to injured gingiva after recent chemoradiation?
Pentoxifylline and vitamin E
How would you approach treatment for a patient with locally advanced NSCLC and systemic scleroderma if chemoradiation is their only curative option?
My advice would be to provide some consent that there may be some increased risk of toxicity, especially esophageal, and then treat them as you would if they didn't have scleroderma. I think the literature suggesting scleroderma is contraindicated in radiotherapy is pretty soft. There's been some in...
What hotspot and heterogeneity metrics do you utilize when delivering PMRT to a patient who has had breast reconstruction?
I try to follow the same as intact breast. Limiting hot spot < 110 and V 105 < 5-10% and not hot spot in IM fold. Patel et al., PMID 30145393
Do you offer local consolidative therapy for patients with polymetastatic driver mutation-positive NSCLC who respond well to targeted therapy?
This is a great question. In phase II prospective study, Gomez and colleagues (Gomez et al., PMID 31067138) demonstrated a PFS and OS benefit with local consolidative therapy in patients whose disease did not progress after first-line systemic therapy. In my opinion, local consolidation therapy to o...
Would you recommend adjuvant radiation after wedge resection for a 1.0 cm non small cell lung cancer with close margins of 2mm?
We do not recommend adjuvant radiation for close (or even positive) margins after a wedge resection. The rationale for a wedge resection (as opposed to lobectomy) typically stems from some level of medical risk in a patient precluding more standard upfront resection. Difficulty localizing the site o...
What is your approach to solitary node positive bladder cancer (e.g. N1) in a patient who is otherwise a candidate for either bladder preservation or radical cystectomy?
This is a very intriguing question, with limited prospective data to guide us. I will frame my response on a patient with clinical node positive (based on imaging) bladder cancer and a candidate for bladder preservation or cystectomy. This patient is deemed metastatic yet there may be a subset of t...
What is the best management of an unruptured Spetzler Martin grade 3 arteriovenous malformation in a young patient?
This is a complex question and first and foremost requires and understanding of the natural history of an AVM.Natural history of cerebral arteriovenous malformations: a meta-analysis Nine natural history studies with 3923 patients and 18,423 patient-years of follow-up were identified for analysis. T...