Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
How do you counsel a patient with early stage breast cancer, planned for breast conserving surgery, who wants implants at the time of surgery or soon thereafter?
I usually say something like: “Let’s cure this cancer first and then address the implant issue down the road. I would not want to do something now related to cosmetic concerns that might complicate our ability to optimally treat your cancer. While the cancer appears to be favorable, etc., and implan...
Would you offer consolidative RT for NEC of the esophagus with good response to systemic therapy?
Yes
How would you manage a premenopausal patient with HER-2 positive DCIS in the setting of a prior HER-2 positive contralateral breast cancer?
NSABP B-43 looked at the combination of post-op RT + trastuzumab vs RT alone in HER2+ DCIS and while there was a numerically lower number of IBTR events in the trastuzumab arm, this did not reach statistical significance. At this time, we do not manage our HER2+ DCIS patients differently than HER2-....
Do you hold anticoagulation prior to prostate brachytherapy?
Yes, but always per the patient's cardiologist's recommendation. Also not even after the designated time for withholding meds may still be anti coaged so we get pt/ptt morning of the procedure.
How would you approach a patient with low grade follicular lymphoma (stage IE) of the breast who presents with local recurrence 1 year s/p lumpectomy?
I would re-stage the patient with imaging. If the disease remains localized, then I would treat with definitive RT (24-30 Gy in 2 Gy fractions using ISRT principles). It would be interesting to look back at the pathology from the original lumpectomy. Unless margins were widely negative, I would prob...
How do you risk stratify patients with MRI guided prostate biopsies?
If the patient has had standard template biopsies and targeted biopsies, I only consider that standard biopsies in the quantification of the proportion of cores involved since the data used to derive the prognostic significance of this feature was based on standard template biopsies not targeted cor...
Would you offer radiation therapy post lumpectomy for a small melanoma oligometastasis with negative margins?
I don’t know if RT will have benefits for melanoma with negative margins.
How, if at all, does your approach to adjuvant chemoradiation differ with proton beam radiation vs. conventional photon radiation for H&N Cancers?
As there is no prospective data for protons over photons in head and neck cancer, despite the proliferation in utilization, I would not feel comfortable treating this way unless it was the only option.In addition, recent reports indicate a relatively high risk of mandibular ORN, which is hardly seen...
Does acute radiation cystitis cause microscopic hematuria and pyuria?
Radiation cystitis is the diagnosis.