Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you prefer rhTSH for TSH stimulation instead of thyroid hormone withdrawal when treating patients with radioactive iodine for papillary thyroid carcinoma?
There are no long-term level 1 evidences to guide the decision between rhTSH stimulation and TSH withdrawal in preparation of radio-iodine ablation. Two largest randomized studies (Strategies of radioiodine ablation in patients with low-risk thyroid cancer.N Engl J Med. 2012 May; 366(18):1663-73. Ab...
Does a transitional zone vs. peripheral zone location of low risk prostate cancer affect your recommendation for active surveillance?
All other things being equal, the location of the cancer would not impact my recommendation for active surveillance. Transitional zone tumors tend to have a better prognosis than peripheral zone cancers. They are typically found in men who have had an elevated PSA and a prior negative biopsy, which ...
How do you manage dental care, oral hygiene, and nutrition in patients with trismus?
This can be remarkably challenging. Each case must be tailored to the oncologic presentation and discussed with the multidisciplinary team (surgeon, med onc, rad onc, dentist, speech pathologist) and patient. Ideally, your team can try to anticipate short and long-term expections regarding resolutio...
For multiple myeloma patients with vertebral lesions requiring palliative radiation (e.g. 20-30 Gy in 10fx), do you treat concurrently with modern systemic myeloma agents such as lenalidomide and bortezomib?
We found in an institutional retrospective experience that patients with MM can safely be treated with lenalidomide, bortezomib, and cytotoxic therapy with palliative xrt.https://www.ncbi.nlm.nih.gov/pubmed/25176474
What role does laser interstitial thermal therapy (LITT) play in the treatment of primary and metastatic brain neoplasms?
LITT is more commonly used for metastatic brain neoplasms at our institution in certain scenarios. It is used for patients with radionecrosis after Gamma Knife/SRS if patients do not respond to steroids or bevacizumab. It is also used for patients with tumor recurrence after SRS in locations that ar...
Do you intentionally modify your breast cancer treatment plans for those on chronic immunosuppression to avoid secondary cancers?
This will usually depend on their clinical scenario. In case where I would recommend RNI, I will still recommend RNI and counsel on risks of second canceers. In patients with early stage lower risk or disease, one can consider partial breast irradiation if appropriate though I do counsel patients th...
For ALK+ patients rendered NED from oligometastatic NSCLC after resection of both lung primary and isolated CNS lesion, do you consider offering treatment with an ALK inhibitor after adjuvant chemotherapy, or do you place into surveillance?
A large proportion of patients with oligometastatic disease managed with curative intent generally relapse, either intracranially and/or extracranially. TKI therapy maybe expected to prolong disease-free/progression-free survival based on our experience with EGFR TKIs. However, given the expected du...
How do you manage the neck in patients with cutaneous SCC who are at high risk of nodal disease but had a negative neck dissection?
First, I would ensure that the appropriate draining lymph node basins were dissected based on the site of the primary tumor. Next, I would review preoperative imaging to confirm that any suspicious lymph nodes prior to surgery were harvested during the surgical procedure. Then, I would review the ca...
How do you define "low-volume" intermediate risk prostate cancer that is appropriate for brachytherapy alone?
For prostate cancer the use of PSA, T-stage, and Gleason score have been used to create multiple different risk stratification schemes. That of @Dr. First Last, the NCCN, and the AJCC are all very similar. In addition, other methods such as the Memorial Sloan Kettering nomograms and the CAPRA score ...
Would you recommend an inguinal node dissection as part of definitive treatment for adenocarcinoma of the anus with suspicious inguinal nodes?
The only wrong way to approach this is with initial inguinal surgery. I have seen that result on multiple occasions in dermal lymphatic recurrence after standard IMRT because the drainage gets altered. True adenocarcinoma of the anal canal has a poor prognosis due to increased rates of distant failu...