Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When treating trigeminal neuralgia with SRS, are there vascular constraints or concern for late aneurysm?
The incidence of cerebral aneurysms after stereotactic radiosurgery (SRS) for trigeminal neuralgia (TGN) is extremely rare. High-dose radiation (60 - 90 Gy) delivered to local microvasculature can theoretically cause focal vessel wall weakening, elastin degeneration, or radiation angiopathy leading ...
For epidural spinal cord compression in good-performance/prognosis patients who are otherwise inoperable, do you still aim for 30 Gy in 10 fractions, or are you fine with 20 Gy in 5 fractions?
In general, if prognosis is good (e.g., greater than roughly 6-12 months), 30 Gy in 10 fractions is preferred, given a lesser risk of recurrence with epidural spinal cord compression (ESCC) as compared to lower dose regimens such as 4 Gy x 5 in the longer term (e.g., from Rades et al., PMID 15908648...
Would you offer hypofractionated radiation regimens for a young patient with glioblastoma with good performance status but travel concerns, making 6 weeks of radiation difficult?
I am not a neuro-radiation oncologist, but I must register my disagreement with Dr. @Dr. First Last answer. This is GBM. The cure rate is exceedingly low, no matter what the fractionation, age of the patient, PS, etc. We should work with the patient to maximize their remaining quality of life and no...
How do you approach ADT in patients with high-risk prostate cancer who have risk factors for VTE, such as Factor V Leiden?
My default recommendation for patients with localized, high-risk prostate cancer is to recommend the use of long-term ADT. This intervention seems to offer a relatively large, clinically significant OS benefit for patients in the modern era receiving dose-escalated ADT. This benefit has been observe...
How do you counsel your breast-cancer survivors about weight-loss/dietary modifications?
Normal body mass index (BMI) and maintenance of weight is associated with a more favorable outcome (in many series both cancer-related and non-related) compared to higher BMI. Similarly higher level of exercise and metabolic equivalent (MET) is also associated with better outcome in many observation...
How would you treat a patient with UC and a J-pouch presenting with basaloid carcinoma of the prostate who is not a surgical candidate?
This is a difficult scenario. One way of approaching this is by considering SBRT to the prostate and seminal vesicles after placing a rectal spacer. The typical dose is 3,625 cGy in 5 fractions, given on alternate days. Ensuring there is no bowel (small or large) within proximity of the superior asp...
Do you offer consolidation durvalumab in a patient who had pneumonitis requiring steroids following chemoradiation for LS-SCLC?
In the ADRIATIC trial, pneumonitis or radiation pneumonitis occurred in 38.2% of durvalumab-treated patients, and 8.8% discontinued treatment due to pneumonitis (Cheng et al., PMID 39268857). While there is emerging interest in immune checkpoint inhibitor rechallenge after successful management of i...
Would you offer cisplatin concurrent with radiation to a patient with p53-mutated stage III endometrial cancer if she has adult-onset hearing loss and uses a cochlear implant?
Cisplatin is commonly used for radiosensitization in patients being treated for gynecologic cancer. Ototoxicity is a common side effect of cisplatin. It is caused by the death of outer hair cells in the inner ear. Cochlear implants are used to treat hearing loss in patients with severe hearing loss ...
How do you counsel a patient with NCCN favorable intermediate prostate cancer but a high risk Decipher score?
Active surveillance has become the preferred management strategy for most men with low-risk prostate cancer and is increasingly used in carefully selected patients with favorable intermediate-risk disease. However, men with IR PC have approximately a three-fold greater risk of tumor upgrading or pro...
Is a larger prostate size or volume associated with a higher absolute PSA bounce after radiation?
I have not seen anything in the literature to indicate that the magnitude of the PSA bounce is related to prostate size, but it's certainly possible. The highest bounces I have seen after treatment were in patients treated with LDR brachytherapy (my personal record is 8 ng/mL, and it eventually beca...