Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When treating node positive anal squamous cell carcinoma, dose your lymph node boost include only gross disease with margin or do you boost the entire nodal region?
Boost is to involved node with PTV margin and dose is a function of nodal size
Would you recommend consolidative RT for a mediastinal germ cell tumor with partial response after chemotherapy?
There is no evidence or logic in postchemotherapy radiotherapy for patients with residual mass with nonseminomatous germ cell tumor. Instead such patients should be referred to a thoracic surgeon with experience and skill in resecting residual masses. For mediastinal seminoma, there will almost alw...
How do you manage painful (non-sbrt) bone metastases in patients receiving nivolumab or other immunotherapy?
Patients on immune checkpoint inhibitors are at risk of developing serious adverse effects from the agents themselves, which can impact on the delivery of radiation. For example, they can develop an immune mediated colitis, which can mimic acute radiation enteritis, but the management is completely ...
In a patient with newly diagnosed high risk prostate cancer, how do you work up a bone scan showing suspicious areas of radiotracer uptake?
This a great question. In the setting of abnormalities on the bone scan, I would take 2 actions. First, I would certainly get local imaging of the abnormal site, with a CT, MRI or X-ray, depending on the location. I would also use the patient's clinical scenario and treatment response to help in the...
Are there specific high riks features for which you would offer palliative adjuvant head and neck radiation in the setting of metastatic disease but without residual gross head/neck disease?
This question is worded in a confusing way. As I understand it, the scenario relates to a patient with both local and distant disease who is treated with chemotherapy and has a clinical complete response at the primary site. The question then is whether to add RT to the primary site. We would do so ...
Would you offer whole abdominal irradiation to a pelvic recurrence of rhabdomyosarcoma with tumor rupture / spillage?
I would be less inclined to use a large field / volume approach like whole abdominal RT in the setting of recurrent disease. While I don't know if prior RT was delivered or not, the outcome for children with a pelvic recurrence (especially is a local recurrence) is overall very poor with only 20-30%...
If a patient develops a radiation recall reaction do you typically recommend avoiding the causative chemotherapy in the future?
Depends on severity and response to steroids. If grade 2 or less, might consider restarting the implicated agent (if no other options) at a low dose and titrate up if tolerated. Recently published an article on radiation recall pneumonitis secondary to immunotherapy
Does the presence of interstitial cystitis disease affect your decision to offer post prostatectomy salvage radiation therapy?
The existence of pre-existing interstitial cystitis does not change my recommendations for 1) the need for salvage RT, or 2) the dose/volume. Certainly this man would not be ideal for adjuvant post-operative RT, but with the results of RADICALS and RAVES, adjuvant post-operative RT should be offered...
Following mastectomy with a SNB and single positive axillary lymph node, would you refer a patient back for an axillary dissection if she has borderline indications for PMRT?
For macromets: If there is no indication for PMRT, then patients are referred back for ALND. That being said, there are patients who decline ALND because of lymphedema and in these patients do perform PMRT with RNI in lieu of ALND . For micromets: No additional axillary intervention and no addition...
Do you offer concomitant chemotherapy and radiation to patients with locally advanced ulcerated breast masses that have good performance status and are potentially curable?
I tend to evaluate these on a case by case basis: 1. Locally advanced, potential for surgery but not resectable currently, already received some systemic therapy- Consider chemoradiation usually with xeloda 2. Locally advanced, limited/no potential for surgery- usually go with chemo first and if no ...