Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach a T3N1M0 mid rectal cancer that is MMR deficient?
About 2.7% of rectal adenocarcinoma are mismatch repair deficient (dMMR) (Papke Jr. et al., PMID 36322852) and locally advanced dMMR rectal cancers have a great response to immunotherapy. Six months of single agent Dostarlimab led to 100% complete clinical response in the phase 2 study including 14 ...
How would you manage a patient with muscle invasive bladder carcinoma with multifocal CIS who refuses cystectomy?
Concurrent chemo RT with 55 in 20 to whole bladder.
What dose/fractionation would you consider for salvage re-irradiation of a vestibular schwannoma after fractionated stereotactic radiation, >4 years later?
Salvage re-irradiation for vestibular schwannoma (VS) is far from "routine" for several reasons. First and foremost, progression of a small vestibular schwannoma after adequate SRS/FSRT is quite uncommon. More common is a phenomenon comparable to pseudoprogression, and the first and foremost compone...
How do you manage patients with persistent/recurrent disease in the neck >6 months after receiving definitive chemo-RT for p16-negative oropharyngeal SCC?
Surgery with likely re RT chemo.
In light of recent WHO classification update for glioma, how would your treatment volumes and dose prescription change for a non-enhancing molecular glioblastoma?
I would argue that the CTV for a molecularly defined IDH-wt tumor without radiographic hallmarks of contrast enhancement should be considered differently than for those of a more "classic" radiographic/histologic GBM (i.e., with mitoses, endothelial proliferation, atypia, necrosis). It's a different...
What is your go to steroid regimen for post SRS headache?
Start with Dex 2mg. If that works, then that's it. If it continues, can take a second dose later in the day. It is usually transient, so I don't prefer to give high/long doses and just manage as it comes. Typically, in a day or two, it appears to resolve in my experience.
How would you treat margin positive, node positive (pN+) prostate cancer with detectable post-op PSA but negative PSMA-PET after radical perineal prostatectomy?
Ideally, enroll the patient in a clinical trial like NRG GU-008. Off trial, would treat with salvage RT to the prostate bed and lymph nodes with long term (2 years) ADT. You can consider an MRI to see if there's a nodule in the prostate bed to boost, which may be more likely given a positive margin....
How do you manage an infection that occurs in the treatment field while under treatment?
I believe it is rare to develop an infection within the treated volume. When it does happen, treating with antibiotics and continuing treatment is probably best. If it is an abscess, then sometimes drainage with possible re-planning is necessary. I generally do not stop treatment unless the patient ...
How would you manage an endometrial adeno abdominal wall recurrence at the port site from prior laparoscopic surgery?
I agree with R0 resection and would echo postoperative RT if it is the only site of disease. Oncologic abdominal wall resections are not routine for most surgeons and don't have standardized approaches. Make sure that your surgeon and pathologist understand that you want it evaluated similarly to a ...
How would you approach a patient considered to be unfit for cystectomy with recurrent NMIBC refractory to BCG, failed pembrolizumab and unable to do more intravesical Rx?
This seems to be a very difficult scenario, what are the reasons for not being able to pursue intravesical therapies? Nadofaragene firadenovec just got FDA approval, while there have been data with intravesical gemcitabine/docetaxel. We are waiting for the FDA decision on N-803/BCG combo (QUILT-3.03...