Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can the tracheostomy be reversed after completion of chemoradiation for laryngeal cancers?
Yes, if there has been a CR. Wait 3 months. PET. If negative, plug trach for 2 weeks. If all is well, pull trach.
Would you ever discourage salvage prostate XRT given a patient's lower urinary tract symptoms?
If the patient has post-op obstructive symptoms, it's possible the patient may have a bladder neck contracture. They might benefit from a urologic evaluation with cystoscopy which might address the issue. I would try to have that done prior to salvage RT. It is conceivably possible that there also c...
What are the indications for adjuvant radiation for a resected intracapsular carcinoma ex pleomorphic adenoma of the parotid?
It is unclear to me how the "intracapsular" component would change management since I am not familiar with this entity. However, carcinoma ex pleomorphic adenoma is a high grade cancer and merits PORT. If neck is pN0 after an adequate dissection, theoretically does not need treatment. In treating ...
What is your preferred dose and fractionation schedule for a patient with a stage III non-small cell lung cancer, whose comorbidities preclude chemotherapy, but has good enough performance status to warrant an attempt at longer-term local control?
This is a very good question. I'd say the answer to this one is evolving! Typically the patients who cannot tolerate either sequential or concurrent chemotherapy for locally-advanced NSCLC are quite frail and/or have comorbidities that are significant. The results using radiation alone for Stage III...
How exactly would you utilize ADT via leuprolide or bicalutamide with salvage RT post prostatectomy with PSA >0.5?
The dilemma on the need for hormonal therapy in the salvage radiation setting after radical prostatectomy is a major one in current clinical practice, driven by the modest survival benefits seen in the RTOG 9601 trial with 2 years of bicalutamide (Shipley et al., PMID 28146658), but also follow up s...
For lung SBRT, do you constrain dose to small bronchioles/small airways?
Hi MedNet,I got this question via email as well and answered it there, but for the broader community, I’ll answer here too.I do not. There are many ways to think about problems like these and a lot depends on the patient’s characteristics. There’s a convincing amount of anecdotal data that ultra cen...
Are there any breast ca patients for whom you would offer PMRT if they were cN0 and ypN0?
There are a few patients, I will still offer RT for if they are cN0 and ypN0. cT4 disease T3N0- will consider for young age, triple negative I don't routinely offer to cT1-2N0 patients unless positive margins.
Do you offer consolidation chemotherapy prior to durvalumab in locally advanced, unresectable NSCLC?
I do not offer consolidation chemotherapy to patients prior to durvalumab in patients with locally advanced, unresectable NSCLC. The PACIFIC trial was a randomized phase III trial that established the role of consolidation durvalumab after definitive chemoradiation for patients with stage III NSCLC....
How do you counsel patients/families whose goals of care are clearly aligned with a comfort-focused, end-of-life approach, but who are hesitant to formally enroll in hospice?
Hospice sounds like a 4-letter word to a lot of families! I find it important to distinguish the philosophy of comfort care vs. the benefit package associated with enrolling in hospice. Some people are able to be provided end-of-life comfort care without electing the hospice benefit, and that is fin...
How do you classify extensive LVSI in endometrial cancer?
There are various definitions floating around but one with an outcome in the absence of nodal dissection is from PORTEC group showing the significance of 4 or more vessels involved.Peters et al., PMDI 34261899 Our data questions the true significance of substantial LVSI > 1 vessel as used in previou...