Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer palliative whole liver radiation for patients with diffuse liver metastases?
Whole liver radiation is a very good palliative treatment for diffuse hepatic metastases causing pain or severe nausea/vomiting. I treat the whole liver plus a 1 cm margin to 7-8 Gy/1 fraction per the Phase II trial from Princess Margaret Hospital (Soliman et al., PMID 24062394). In this trial of 41...
Would you recommend discontinuing testosterone replacement in a male patient in his 60s with newly diagnosed favorable intermediate-risk prostate cancer who is declining surgery and will receive definitive radiation?
Historically, we (as a field) have viewed TRT as the opposite of ADT and therefore inherently problematic. I am not convinced this is logical. ADT has RCT evidence to support it, whereas withdrawing TRT has not been as cleanly studied. Let's say we stop TRT, and this drops their testosterone to 150 ...
How do you talk with your patients regarding radiographic expectations on surveillance CT after lung SBRT?
In general, especially when I have a discussion about the 3-month follow-up scan and tell patients that the lesion may likely be stable in size, which is often normal, and not to panic. There may also be post-radiation changes that make it more difficult to initially interpret. I think this highligh...
How would you treat a child with an unresectable inflammatory myofibroblastic tumor of the lung with progression on crizotinib?
To give you an honest take, this is an impossible question to answer properly without more clinical context.How you manage this patient depends entirely on information not provided here: the exact anatomic reason for unresectability, whether there is central airway or vascular compromise, the patter...
What options do you have when a patient has urinary obstruction during radiation treatment?
Here is my general practice on urinary symptom management for a man with prostate cancer undergoing RT.Urinary symptom management RT can decrease urinary symptoms in men with irritable urinary symptoms (Malik et al., PMID 20643513) - not sure of the mechanism, but it takes time to see the IPSS drop ...
In what patients is it inappropriate to offer DCISionRT testing?
Appropriate or inappropriate... not quite how I think about it. Most of my patients come with it done. Here are various reasons why a low score won't change my mind about whether to treat or not. Large and high grade - i.e., >2.5 cm and grade 3. I don't feel comfortable omitting from this group. Po...
How would you treat a high grade sarcoma of the breast?
First, primary breast sarcomas are rare and heterogeneous, and no clear universal guidelines exist and these patients should be managed on a case-by-case basis, preferably at a tertiary care center with expertise in sarcoma. Histologies include angiosarcoma (primary or radiation-associated) and undi...
Are the results of CONKO-007 changing practice for the management of pancreatic cancer?
The results of CONKO-007 are exactly as expected. The clinically relevant endpoint of OS was not improved with the addition of chemotherapy. These results are similar to the PREOPANC-2 trial in BRPC. Since definitions are rarely followed in practice, BRPC and LAPC populations have merged over time; ...
Would you consider neoadjuvant immunotherapy followed by radiation for a patient with locally advanced basal cell carcinoma?
This is a relatively data-free area, so there's no “right” answer.I think the first question to ask is whether this basal cell carcinoma (BCC) is amenable to curative intent radiotherapy (assuming surgery is not possible). If so, any adjunctive drug therapies are of secondary relevance.For locally a...
Given the new ASCO guidelines on SNB in early stage breast cancer, how does the omission of SNB in patients aged 50-70 impact your adjuvant radiation recommendations?
If the patient is otherwise a good candidate for APBI (age > 50, pT1 tumor, ER+, HER2 negative, Recurrence score low and intending to take endocrine therapy) that was clinically node negative and ultrasound axilla negative, I feel completely comfortable treating with APBI post lumpectomy with negati...