Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When a patient presents with 2 lung lesions, do you routinely recommend a biopsy of both lung lesions?
2nd lesion may be a satellite met.
How would you manage a superior sulcus tumor following 45Gy induction chemoradiotherapy then resection that left gross residual disease in the bony spine?
This is exactly why I NEVER do this. If the surgeon feels that an operation is essential, I’d prefer maximally debunking surgery with extensive clipping of involved regions followed by chemo-radiotherapy. This has been my strategy for many years, including Moffitt and MD Anderson. We have published ...
What are the indications for radiation after cord stripping for early-stage glottic cancers?
Not sure I understand the question to be honest. Regardless, vocal cord stripping is not a common procedure these days. My surgical colleagues say it is only used for benign epithelial lesions (eg. polyps). And a quick PubMed search for "vocal cord stripping" shows studies dating back to 1945! I've ...
How would you approach the treatment of isolated lesions within the spleen for a patient with metastatic small cell lung cancer and well-controlled disease elsewhere after chemotherapy?
While it may be tempting to consider SBRT for this oligoresidual case, there really isn’t a lot of data to support such a strategy. Extensive stage small cell has a poor prognosis, and the roles of pci and consolidative thoracic RT have camps of believers and non-believers. RTOG 0937 was a consolid...
How do you think through the various treatment options for patients with unfavorable intermediate risk prostate cancer?
The first thing I do is make sure that I have plenty of time blocked off for this consultation, because these tend to be long encounters, and may require follow-up visits and/or phone calls to address all of the patient's questions. I think these are the most complex of all GU consults. The next thi...
For a patient with remote history of mantle field radiation for early stage Hodgkin's lymphoma, now with oligometastatic breast cancer, would you offer SBRT to chest wall metastasis?
In the setting of previous radiation (mantle, previous breast RT, etc), it's important to see what the total dose was and how long since that radiation was delivered. In terms of oligometastatic disease with chest wall metastasis, is this de novo or following initial treatment? If de novo, we typic...
What intracavitary brachytherapy regimen would you use after EBRT for a 4cm vaginal leiomyosarcoma the mid vagina with positive margins?
In general. I agree with @Dr. First Last's opinion. Vaginal sarcomas are rare, comprising less than 5% of all malignant vaginal cancer. Therefore, experience is limited and published reports sparse. It is stated that in this patient the tumor WAS 4 cm (in diameter?, largest dimension?) I assume it h...
How do cytopenias factor into your decision of whether to hold radiotherapy during treatment of a glioblastoma?
Patients will sometimes need a chemo dose reduction or hold, but we typically do not stop RT, once started. In the case of severe cytopenia, I might hold RT on a case-by-case basis (e.g., platelets <10k despite holding temozolomide) and in discussion with the neuro-oncologist.
What is your approach to extremity STS (G2-3) after an initial unplanned (non-oncologic) surgery who is planned for oncologic re-excision?
I, too, usually offer pre-operative radiation therapy in these cases with plans for re-resection by our sarcoma surgeons. I am generally a proponent of neoadjuvant therapy as the volumes are smaller, there is less confusion of the field in need of treatment, the dose is less, and, as I see patients ...
How do you choose between SBRT and RFA for CRC metastases to the liver?
Local tumor control rates for radiofrequency ablation in appropriately selected patients are >90%. It also has convenience and cost-effectiveness advantages over SBRT. Typically the tumors that are peripheral are amenable to this, but there are there also the tumors that may not result in a survival...