Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In patients receiving concurrent chemoRT for lung cancer, do you have thresholds for cytopenia at which you would hold RT?
Before the cell recovery stuff, which is now falling out of favor I hear, my constraints for holding RT in these types of cases were: * Platelets 20K or less: spontaneous bleeding can occur at this point or lower. * Absolute Neutrophil count (ANC) of 0.5 or less. I know some folks have an ANC cut-of...
How do you manage an elderly, high risk prostate cancer patient who refuses any local therapy?
In general, for patients who refuse treatment, I try to understand their goals and their fears. Often, elderly patients state that they are ready to die, and don't want to prolong their lives. If I think that treatment is likely to significantly improve the quality of their lives, I will explain why...
In an adult with localized spinal myxopapillary ependyoma managed with subtotal resection and 54 Gy radiation, how long should follow up MRI imaging continue, with what frequency, and for what volume?
This is an excellent question. I don't think we have clear surveillance guidelines for many primary spinal tumors, including WHO gr. 2 ependymomas like myxopapillary ependymoma. In our institution, we generally obtain total spine MRI with dedicated imaging at the tumor level q4 months in the first 2...
For bone metastases requiring surgical stabilization, what time interval from the date of surgery do you use for post-op radiation?
Generally, the surgical stabilization minimizes the capability of short-term catastrophe in (like path fracture), what I presume to be a long bone that has undergone surgical stabilization. I'd probably want to give a few days just to maximize local wound healing but starting sometime, maybe 1-2 wee...
In stage IIIC endometrial adenocarcinoma, does the finding of positive pelvic or para-aortic nodes after lymphadenectomy influence your whole pelvic dose?
The pelvic or pelvic plus pa dose is 45 Gy in 25 fractions for us but these suspicious nodes we would deliver concomitant boost dose of 55 Gy in 25 fractions . Iif patients have a positive pelvic node and the pa nodes were not assessed surgically we would extend field to cover pa region up to renal ...
Would you omit post-lumpectomy radiotherapy for high clinical risk, but low molecular risk DCIS?
For now, I have been only omitting/discussing omission if both, clinical path and molecular test are concordant.
How does LVI affect PMRT decision in a node positive patient?
I consider LVI a risk factor for node positive patients and do use as part of my consideration for PMRT.
What is your approach for PMRT when the patient has a DIEP flap?
I would say that the presence of a DIEP flap does not change my approach to PMRT much. I look to cover the chest wall and regional nodes (+/- IM nodes) similar to a flat chest wall or expander/implant case. In my experience, the only change that sometimes happens is planning as the DIEP can sometime...
What is your criteria for undetectable PSA value after prostatectomy?
In the era of ultra-sensitive PSA, reading below threshold of .2 ng/ml also reflects biochemical recurrence especially in the right context. That being said, if values are low like above, we generally repeat PSA to see the trend rather than act on treatment on single value.
Can you safely proceed with breast irradiation during treatment with immunotherapy?
In KEYNOTE-522, RT was done with concurrent Pembro after NACT plus IO and no significant additional untoward effect was reported. So, we do RT routinely with Pembro for these patients.