Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend Radium-223 for extensive bone disease in a prostate cancer patient with adenopathy >3cm?
I think that there are several nuances to this question. One, Xofigo is a calcium mimetic which has shown both overall survival advantage as well as improvement in symptomatic skeletal events for men who progressed on docetaxel or refused chemotherapy in the ALSYMPCA trial. Patients experienced less...
How would you manage lung adenocarcinoma in a patient with an index lesion requiring treatment, who has additional slowly evolving GGOs/subsolid nodules?
In our institution, when dealing with the patient who has multiple GGOs, treatment is usually initiated when serial CT imaging shows growth AND development of solid features in a given lesion. We attempt to biopsy if not medically contraindicated and do formal staging including PET and EBUS staging,...
Would you consider cystectomy in a patient who acheived radiologic and cystoscopic CR from chemo-radiation for oligometastatic urothelial carcinoma originating in the bladder if remains disease free > 6 months?
For this patient, I would currently recommend 4-6 cycles of cisplatin based chemotherapy followed by avelumab switch maintenance therapy. I would strongly consider radiation or chemoradiation after the combination chemo directed at the bladder and lymph node, followed soon after by avelumab. I think...
If you saw a medically inoperable patient for chemoRT for muscle-invasive bladder cancer who had a congenital recto-urethral fistula, would you deliberately exclude the prostate/prostatic urethra from the target volume?
First, I would want to know about this fistula and why it couldn't be addressed when the patient was a child (what other medical factors might be involved?). Also, the exact location of the fistula would help inform a response to this question. Finally, the nature and location of the bladder tumor i...
Do you consider SABR for oligometastatic disease in patients with TP53 germline mutation?
The question at its core is asking would you give RT to a patient with a genetic condition making them more susceptible to RT-induced secondary cancers. This case discussed TP53 mutation associated with Li-Fraumeni syndrome.However, the case is a patient with oligometastatic disease. This is challen...
How would you manage a patient with oligometastatic disease in the femoral head?
This is a relatively rare situation and the risks and benefits needs to be individualized. Whenever possible, these patients should be considered for oligometastatic radiation trials such as BR002 and LU002. If large/symptomatic with concern for imminent pathological fracture, ortho can do THA, cry...
Would you still offer adjuvant chemoradiation therapy to a patient with pT3 pN1a rectal cancer who did not receive any neoadjuvant treatment, and whose adjuvant treatment is delayed by 4 months due to post-operative complications?
I don't think that this question can be answered fully as it is posed. As we have obtained more information on rectal cancer recurrence and the relative roles of adjuvant (or neoadjuvant) radiation therapy and chemotherapy, we need to be more selective as to who we treat if we are treating postopera...
For APBI, do you prefer a brachytherapy or external beam technique?
I offer a variety of PBI techniques depending on situation and patient preference.With respect to external beam, I primarily utilize a 30 Gy/5 fraction regimen delivered with VMAT (2-3 coplanar arcs). We use breath hold regardless of laterality and CBCT to reduce motion and reduce PTV expansions. Th...
Are there any types of sarcomas that you use induction and/or concurrent chemotherapy with radiation prior to surgery?
Neoadjuvant chemotherapy is controversial in extremity/trunk STS.Generally speaking, grade 2/3 tumors that are ≥5 cm are at high-risk for distant recurrence despite ~90% local control. For these patients, you can consider neoadjuvant chemoRT. When using neoadjuvant chemoRT, the more common approach ...
Are there any anatomical locations that you would consider omiting preoperative radiation for sarcoma due to toxicity concerns?
Its a risk benefit discussion. Groin tends to be location with significant risk of toxicity particularly in higher risk patients (elevated BMI, smoker, etc). However, for high grade sarcomas there is a clinical benefit and getting these same patients through post-op can be even more challenging. I u...