Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend prophylactic retro-peritoneal RT in an adolescent with paratesticular rhabdomyosarcoma, s/p radical inguinal orchiectomy without a lymph node dissection?
Ideally, in children over 10 years of age with a diagnosis of paratesticular RMS, a retroperitoneal LN sampling (taking 7-12 LNs) at diagnosis should be performed unless obvious gross disease in the nodal region is present. The risk of occult LN involvement is higher in those children 10 years or ol...
Which patients with primary, early-stage NSCLC would you utilize immunotherapy in conjunction with SBRT?
The trial from Chang et al., PMID 37478883 testing SBRT +/- IO for early-stage NSCLC was a randomized phase II trial. Although very exciting results, it's not a phase III trial and does not technically change management. IO agents are not FDA-approved in this setting yet! There are at least 2 phase ...
How do you manage an intramedullary benign nerve sheath tumor post sub-total resection seen on post-operative MRI?
Intracranial schwannomas respond well to low dose SRS (11.5-12 Gy) or SRT (25 Gy in 5 fractions) Slane et al., PMID 28089525 However, both of these approaches use a somewhat higher dose than the spinal cord tolerance doses. Therefore, I would treat the patient on a radiation delivery system equippe...
How do you decide whether or not to cover elective lymphatics when treating cutaneous squamous cell carcinoma of the head and neck with definitive RT?
I dont think there's a good, single, validated tool for determining when nodes should be selectively treated in cutaneous SCC. Various sources suggest risk factors for nodal disease - size > 2 cm, depth > 4mm, poorly differentiated tumors, PNI, LVSI, immunosuppression, recurrent disease, and body si...
How do you treat locally advanced medullary thyroid cancer with postoperative RT?
Medullary thyroid cancer typically presents with extensive LN metastases, and this case represents a typical very advanced case. Cases of more localized cancers which I have treated were characterized by adequate control of the irradiated disease, however, in all such patients disease progressed in ...
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...
For a recurrent medulloblastoma in the posterior fossa several years after initial standard risk therapy (23.4 Gy CSI), and in which the patient is still less than 18, how would you approach re-irradiation?
If the recurrences are localized to the resection bed, I would re-irradiate only the recurrences (and possibly the entire resection bed depending on number of recurrences). If there is evidence of CSF dissemination (recurrences not associated with primary--whether in posterior fossa or not) then CSI...
How do you counsel patients with high risk prostate cancer treated with RT + long term ADT who want to allow their testosterone level to rise above castration before receiving their next Lupron injection?
I would not support this strategy unless the patient is on longer term ADT for biochemical recurrence after prior local therapy. In that setting, intermittent ADT is a viable option supported by literature and could be considered. Otherwise, once ADT is stopped, there's no basis for resuming. The co...
How do you manage favorable intermediate risk prostate cancer patients that have a PIRADS 5 lesion that was most-likely missed in the template biopsy?
Yes, I'd suggest a repeat biopsy before treatment. In the case of radiation +/- ADT, a repeat biopsy may impact the dosimetry of radiation, whether or not ADT is used, and how long ADT is used as part of treatment.
How would you approach a localized but unresectable adenoid cystic carcinoma of the distal trachea?
Curative intent RT