Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
At what PSA do you start calculating doubling time post-prostatectomy?
The problem you describe, I think, also applies to standard assays when values are at or near the limits of detectability. Is an increase from 0.1 to 0.2 in 3 months really indicative of a rapid rise? If you are seeing small changes at low PSA values, and you're not inclined to treat the patient, yo...
How do you manage high risk prostate cancer patients with well controlled Crohn's disease?
My first choice would be to manage them without the use of radiation therapy. A minority of patients with high risk disease are curable with surgery, and the population with inflammatory bowel disease is one that I tend to steer away from radiation therapy. Despite the adverse prognostic features of...
How do you perform geriatric assessment for cancer patients?
This is a HUGE topic. I would like to suggest the following 2 resources that you may find helpful. https://www.mycarg.org/?page_id=898 and the following one helps predict residual life expectancy independent of cancer diagnosis: https://eprognosis.ucsf.edu
How long should the duration of hormones be in post-prostatectomy patients receiving salvage RT?
That depends upon why you are giving the ADT. If you think it is just to improve local control in the prostate bed then 6 months should be more than enough. If it is to address micrometastatic disease, then to be consistent with other precedents, it should be two years. An RTOG trial looking at salv...
What dose and upper field border would you use following transanal excision for rectal cancer found to be T2 by final pathology but without LVSI or perineural invasion?
So this is a rectal adenocarcinoma that was was locally excised and found to be T2 with no otherwise concerning pathologic findings. I use S.P. Bach et al (British Journal of Surgery 2009; 96: 280–290) to estimate risk of LF with no further therapy. The Bach paper is a report of the British TEM regi...
How do you taper steroids for patients with symptomatic edema following standard chemoradiation for GBM?
I agree with above and would add that decreased production of corticosteroids by the adrenals does not typically occur until after a patient has been on steroids for at least 3 weeks. If you have a patient on steroids for less than this time period I suggest a rapid taper that is based on symptom co...
When is post-op radiation not necessary for completely resected ipsilateral neck node recurrence in a previously UNirradiated neck?
I think that in the case you described, a metachronous recurrence of nodal disease should be managed similarly to that of nodal disease presenting at the time of the primary disease. Thus in the scenario presented, the same recommendations for dissected N1 disease apply. Historically, dissected N1 d...
How do you manage early stage tonsil SCC treated by simple tonsillectomy alone?
A simple tonsillectomy is not an oncologically curative surgical procedure. It is analogous to an excision biopsy. Historically, definitive RT was the logical next step for a cN0-1 neck in the setting of an early stage primary & with excellent results (Garden et al from MDACC, & others). A good outc...
Following transanal excision with positive margins for for T1 or T2 rectal cancer, is it more appropriate to proceed with APR or attempt sphincter preservation with RT/Chemo?
The issue of sphincter conservation for low stage, low lying rectal cancers has been a topic of interest for a long time.Unfortunately, there is no clear cut answer to the question. The CALGB ran a Phase II trial a couple of decades ago that addressed the general issue of whether local excision plus...
When treating a high risk cutaneous squamous cell carcinoma post-operatively to the tumor bed, do you include the entire pre-op tumor in your PTV or do you include only the scar with margin?
Generally, the preoperative tumor. It depends on the type and extent of resection and reconstruction.