Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is radiation therapy a treatment option for refractory Paget's disease of the vulva extending onto skin of buttocks and anal margin?
I have treated localized peri-anal Paget's Disease with good outcomes, and there is some data to support this. I have not treated a patient with such widespread vulvar Paget's and I suspect that the morbidity would be significant given the doses required, and the volume to be treated in the case you...
Do you offer treatment of prostate/oligomets upfront with systemic therapy for oligometastatic de novo prostate cancer?
There's no right or wrong answer here, and I've done both options (treat everything up front and treat sequentially) based on disease sites and volume, and patient symptoms and priorities. I can share how I think through the decision-making: Do they qualify for prostate RT based on STAMPEDE and life...
How do you assess and counsel women with chronic post-lumpectomy or mastectomy pain?
Post-surgical breast pain is not uncommon. Estimates suggest that 25-60% of patients having breast surgery experience persistent pain, with symptoms lasting from months to years following breast cancer diagnosis and treatment (Langford et al., PMID 25439318; Gartner et al., PMID 19903919).Initial as...
When do you start ADT for a patient with a new diagnosis of node positive prostate cancer receiving radiation?
I would reverse the question order. For node-positive disease, I start ADT once staging imaging is complete. If logistically practical (as with high-risk localized), I often perform the simulation and start ADT at the same time, then start RT without a neoadjuvant period. Evidence for neoadjuvant AD...
For patients undergoing bladder preservation therapy with trimodal therapy, how do you manage the urinary urgency and frequency during and after treatment?
This can be a difficult problem to manage because I try to avoid treatment interruption if at all possible, which is different from my approach in patients with prostate cancer, where treatment interruption is a safe and effective alternative. In patients with bladder cancer, the first thing I will ...
Should TNF inhibitors be held in patients undergoing radiation therapy?
We do not hold TNF inhibitors when needed for patients undergoing radiation therapy.
Would you recommend radiation or chemoradiation in a patient with cholangiocarcinoma s/p surgery and adjuvant treatment with single hepatic metastasis 3 years later?
Challenging case and worthy of tumor board discussion. I would likely start systemic therapy, and if response, consider regional therapy with resection or SBRT, assuming the hepatic function is adequate (keep in mind, TARE can cause liver disease). I have one patient in a similar situation, now > 5 ...
Based on the recent guidelines, should prostate SBRT dose be no higher than 3625 cGy in 5 fractions?
We have delivered prostate SBRT in high volume using 3,800 cGy/4 fx since 2006. The UCSF group has also used this schedule in a large number of patients for a similar time frame. For over a decade prior to that, the exact same dose regimen was used with HDR brachytherapy and published as "safe and e...
Would you electively cover the neck for intermediate grade mucoepidermoid carcinoma of the salivary gland?
I cover the level II and upper level III nodes in these cases. These are essentially already covered in the field when treating the parotid bed and surgical scar in most cases. It does not increase the volume by a lot when including these elective nodal regions.
Would you ever consider chemoradiation for bladder preservation in someone who has had prior LDR prostate brachytherapy?
The board answer is no, he should have a cystoprostatectomy, but that is often not practical. Bladder cancers may arise in men after the brachytherapy either as a result of that treatment or incidentally. The radiation induced cancers appear more than ten years later by which time the men may be in ...