Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach a patient with prostate cancer with sclerotic/lytic lesions found on a CT scan but not seen on a bone scan or PET-PSMA?
This can be a tough situation, as sometimes healthy individuals can have sclerotic or lytic foci in various bones for reasons unrelated to any type of malignancy. The first thing I would try to do is compare the CT scans to any prior imaging if possible. If these lesions are completely unchanged fro...
Would you offer partial breast irradiation for women with G2 4cm DCIS with close margins of 1mm but a very large breast size?
Although size cut off is arbitrary, DCIS tumor size is one of the risk factors for IBTR. For large-volume DCIS like this case in question, what is not known is if a 1 to 1.5 cm CTV margin would capture all microscopic areas of disease or do we need to treat larger volumes. For that reason, I favor I...
How would you approach treatment of a patient with recurrent choroid plexus papilloma with intraventricular dissemination?
The management of choroid plexus tumors starts with diversion of the CSF flow, especially in this patient with a recurrence in the 4th ventricle. A gross tumor resection (GTR) is the most significant prognostic factor, but in this patient, it might not be feasible due to the dissemination in the lef...
What is the most convenient and reproducible setup for simulation and treatment of the contralateral testis in a primary testicular lymphoma?
Frog leg position with the penis taped to the pubic/abdominal wall. Usually, electron beam with energy based on thickness and dose of 24 Gy.
Would you recommend radiation to a painful rib fracture in a patient with multiple myeloma on systemic therapy with ongoing response to treatment?
It depends if it’s a newly diagnosed MM setting versus relapsed MM setting with a rib fracture. Some possible scenarios: For the ND setting, systemic therapy with adequate pain management early on is preferred. For relapsed setting, if the rib fracture heralded the relapse then systemic therapy/pai...
How would you approach adjuvant therapy for a patient with a single lymph node positive in the peri-prostatic fat without pelvic lymph node dissection?
I would favor treating like node positive prostate cancer adjuvantly with long term ADT and RT. Presuming post op PSA is undetectable.
How would you manage pleomorphic adenoma of minor salivary glands involving hypopharynx/larynx with positive surgical margin?
Postop RT with carcinoma doses.
How would you manage primary breast osteosarcoma?
Osteosarcoma of the breast is a rare and highly aggressive tumor, accounting for less than 1% of all primary breast malignancies. Due to its infrequent occurrence, there is a lack of prospective studies to determine the best treatment approach and most publications are case reports. Instead of focus...
How would you manage de novo oligometastatic NSCLC with an isolated low cervical node metastasis?
I view the presence of an isolated low cervical node as somewhere in between an advanced stage III (since supraclavicular/scalene is N3), and oligometastatic stage IV. In either case, assuming the patient received several cycles of induction systemic therapy without progression, I do believe there i...
Does a transperineal approach to prostate biopsy change your treatment plan compared to transrectal?
The short answer is no. The typical scenario in which I have seen transperineal biopsies done is a patient with multiple negative transrectal biopsies in whom there is still a concern for clinically significant prostate cancer and an MRI has not identified a target to biopsy. In these cases, multipl...