Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you define the role for radiation in the management of a primary vulvar leiomyosarcoma in close proximity to anus?
Favor surgery followed by RT unless not operable without compromising anal function.
What are your typical dose and fractionation schedules for post-prostatectomy radiotherapy for a patient with involved pelvic lymph nodes?
I typically use conventional fractionation for post-prostatectomy RT. The recently published experience from Wisconsin showing a continuous development of significant late effects with longer term follow-up for moderate hypofractionation in this setting, I believe, is cause for concern, so I have no...
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
Germ Cell Tumor Management in face of SARS-CoV-2: Safe, Rational Modifications to Standard GCT Practice to Protect Public Health, GCT Outcomes, GCT Patients, and Health Systems. This bulletin has been produced by a concerned group of international experts in germ cell tumors, has not undergone exten...
How would you manage the side effects/toxicities (e.g., pain, swelling, erythema) of adjuvant EBRT to the ear for cutaneous SCC?
I have had a few patients experience acute pain in the ear canal, probably from inflammation, wet desquamation, and bacterial overgrowth. Ciprodex Otic drops x 7-10 days have been helpful.
How will the results of NRG GU006 and the use of the PAM50 genomic classifier impact treatment for recurrent prostate cancer?
Top line results: The prostate cancer-adapted PAM50 gene expression biomarker was validated in the NRG GU006 randomized trial to predict the differential benefit of hormone therapy, specifically apalutamide monotherapy, for patients with recurrent prostate cancer after radical prostatectomy being tr...
In resected N2 NSCLC, what nodal pathologic characteristics prompt you to recommend PORT?
Increasingly difficult question to answer with the evolution of neoadjuvant and adjuvant treatment paradigms. We know from both Lung ART and PORT-C that the addition of PORT in completely resected patients with N2 disease improves locoregional control across the cohort as a whole; however, this did ...
How do you approach designing the boost volume when PMRT is recommended for the indication of positive margins?
Have favored the positive quadrant with a scar if the deep margin is positive.
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
How would you empirically manage a large sellar/suprasellar mass with encasement of the right cavernous and terminal internal carotid arteries?
Knowing the histology of the mass would really help in creating more accurate treatment recommendations. A biopsy of a sellar mass is usually accomplished by an endonasal-endoscopic transsphenoidal approach utilizing the expertise of an ENT surgeon and a skull-base neurosurgeon. However, in this cas...
Would you consider radiation alone or chemoradiation therapy for a small vulvar cancer near the urethra or clitoris?
Yes, I think radiation is worth considering in this situation. However, the morbidity of radiation is also significant with potential for edema and fibrosis in high dose volume. The consequence of that may arguably be worse than surgery. If we do treat with radiation, I would still add chemotherapy ...