Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat primary small cell cancer of the trachea with spread to paratracheal lymph node any differently than a limited stage SCLC?
I would treat this the same as limited stage SCLC. This is not particularly common, though, in these settings, I do work closely with our interventional pulmonary team to preserve the airways while starting treatment, and maybe a situation to consider inpatient treatment for close monitoring, depend...
Would you offer adjuvant radiation for a low-grade cutaneous leiomyosarcoma after R0 resection?
I would not. Cutaneous leiomyosarcomas are relatively favorable lesions with low propensity for recurrence as long as surgical margins are widely negative. The skin is easily surveilled and a local recurrence, in the unlikely event one occurred, would be easily salvageable. I would omit radiation an...
How do you counsel patients regarding timing of dentures after definitive/post-operative H&N radiation with pre-treament tooth extractions?
Wait for at least 3 months for acute healing and for the first post-tx scans to be NED. After that, there can still be subacute changes over the next 6-12 months (post extraction bone resorption, post radiation fibrosis, etc) that would lead a prematurely fabricated denture to lose appropriate fit. ...
Would you offer SBRT to an oligometastatic non-vertebral bony site that already has a pathologic fracture?
If it’s a rib or non-long bone lesion (as they won’t severely impair limb function), SBRT can still be a treatment option. If there is good tumor response, remineralization may occur. For long bones, open reduction + internal fixation have to occur first as in all likelihood, there’s limb deformity ...
For what OPX subsites would you consider NOT treating the high retropx drainage in the node positive neck?
None
How do you approach ADT in a post-prostatectomy patient who had higher Gleason score on biopsy but a lower Gleason score on final pathology?
I would only base my decision on the pathology of the final prostatectomy specimen, and ignore the prior biopsies.
How would you treat a patient with metastatic cancer with a lesion invading the small bowel causing bleeding and potential obstruction?
Radiation reliably relieves bleeding but typically does not relieve obstruction. It may be worth trying if there is not an impending obstruction. We have plenty of experience in rectal cancer that this is a successful strategy. Since it's located in the small bowel, I would use standard fractionatio...
Would you ever consider focal brachytherapy treatment in a patient who have in-prostate recurrences after RT?
Yes, our preference is focal treatment for unilateral disease on imaging (PSMA, PET, and MRI) and concordant biopsies. Our data suggest that this is just as effective as whole gland treatment for recurrences with possibly less toxicity. For patients b/l recurrent involvement after prior radiation tr...
What do you quote as the recurrence risk without radiation for patients that undergo neoadjuvant systemic therapy followed by lumpectomy and are found to have a complete pathologic response?
We don’t have any data to quote and this is still an unanswered question. Rather, there is an interesting phase 2 study omitting surgery in these, it’s showing excellent outcomes.Kuerer et al., PMID 36306810
Is there any role for RT in the management of florid LCIS after mastectomy?
No role of radiation therapy in this case.