Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is it acceptable for a medical oncologist to use Xeloda in place of 5FU when treating GI sites other than rectal?
Yes, we have extrapolated from anal cancer and gastric. Xeloda is safer better tolerated than traditional 5FU.
Are there situations where it's appropriate to offer postmastectomy radiation therapy to patients with biopsy-proven M1 disease?
The two randomized studies evaluating benefit of local treatment for stage IV breast cancer at diagnosis were negative for the end point of improving survival. One from Turkey which randomized patients to upfront local treatment vs. none showed a trend for improved survival for bone only disease on ...
How should masticator space involvement be defined: anatomically or by AJCC's vague definition with regards to Nasopharynx Cancer?
That's a great question. I found the following article (linked below), which showed that the anatomic definition of masticator space independently predicts for increased locoregional recurrence and overall survival, and that since the mandibular nerve passes into the anatomic masticator space, that ...
Does a rare histology prostate cancer, such as ductal or mucinous, change your typical management recommendations?
Intraductal cancers are often associated with Grade 4 prostate cancer and getting a mpMRI and performing a fusion TRUS/mpMRI bx of any PiRads 3, 4 or 5 cancer to r/o Grade 4 would be of value to recommend treatment as opposed to active surveillance in an otherwise Gleason score 6 PC. If Grade 4 is c...
Do you transfuse anemic head and neck cancer patients undergoing chemoradiation?
DAHANCA 5 trial and combined analysis from DAHANCA 5 and 7 showed no benefit to transfusion, so only if symptomatic or other clinical consideration.
Do you routinely recommend prophylactic cranial irradiation for stage I small-cell lung cancers treated with lobectomy and adjuvant chemotherapy?
PCI was 'associated' with better long-term survival even in stage 1, and age and size factors do not seem to matter. However, as the information gets divided, fewer patients fall into each cohort.A recent study published in the JCO, analyzing over 1,000 patients in the NCDB, found that thoracic radi...
Do you recommend delayed versus immediate breast reconstruction in patients who will require post-mastectomy radiation therapy?
There is no absolute answer for this question as it has not been studied prospectvely for us to know what is the best approach. The approach to some extent is driven by patient's choice, her reconstruction options and expectations from reconstruction outcome. In general if we know for sure patients ...
Do you offer hypofractionated courses of radiation with temozolomide for "elderly" patients with GBM?
The ASTRO GBM guideline states the following with regard to elderly patients:“Given the absence of proven superiority for conventionally fractionated radiation therapy, the panel recommends hypofractionated radiation therapy for elderly patients with fair-good performance status (high quality eviden...
When treating a high grade neuroendocrine tumor of the rectum with involved pelvic lymph nodes, do you use the same approach (dose, fractionation, concurrent chemotherapies) as you would for a small cell lung cancer?
I have simply used standard radiation dose and technique with platinum/etopiside or CPT/cis. Twice a day fractionation could be very difficult to tolerate. The proctitis and small bowel toxicity would probably be too severe.
How do you incorporate the recent proposed guidelines for using a prostate cancer "Grade Grouping" system (i.e. scores 1-5) into your clinical practice?
As theMedNet is a less formal venue for discourse I will do away with any pretense and answer the question honestly. I have no idea how I or anyone should incorporate this new system into practice. Although validated, the new system has not been used in randomized trials and one musn’t be overly dog...