Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient who has poor pulmonary function test results, do you treat esophageal cancer with concurrent chemoradiation therapy?
Yes, preferably with protons.
For a refractory GI bleed, would you ever consider re-irradiation of an unresectable gastric or GEJ tumor in a patient previously treated with definitive chemo-RT?
We do this occasionally, with good success and no major complications of which I’m aware. This is likely due to 3 factors: 1) There has been substantial repair after the first course. Our crude rule of thumb is 50% repair after one year. We very rarely re-irradiate before this. 2) Low dose to provid...
How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?
In my experience, tumor boards serve 2 purposes. Firstly, they are designed to bring multiple specialists and cancer providers together in real-time to facilitate patient care. Secondly, they help educate the various disciplines based on a robust interaction. Virtual conferences are complicated by d...
When would you recommend standard of care over hypofractionated treatment in an elderly patient diagnosed with Glioblastoma?
Treatment of patients with newly diagnosed GBM who are >70 years of age is controversial and treatment decisions should be individualized. Some patients who are GREATER THAN 70 years of age are candidates for standard 6-week RT+TMZ and some patients who are LESS THAN 70 years of age may require modi...
How do you discuss curative vs palliative treatment intent for patients with favorable risk 1p/19q co-deleted oligodendrogliomas?
Although my name is on a publication calling low-grade oligodendroglioma an "incurable disease", this is not a term that I use with patients — even in the case of glioblastoma. We do not have a published 20-year follow-up of RTOG 9802 to see if there is a plateau in PFS. Are we only delaying inevita...
How would you approach radiation for a patient with limited stage small cell lung cancer who refuses chemotherapy?
As the standard of care is systemic therapy for all that are medically fit, I’d spend time probing reasons, or the legitimate fears and concerns trying to change their mind. If limited disease, I would discuss the reasoning for local therapy, start with the standard (45 Gy/BID/3wks) and consider the...
How do you manage unresectable granular cell tumors of the orbit?
Try RT. Unresectable is unresectable.
Do you measure testosterone in men who will be receiving ADT?
I do check before starting ADT. I make sure to check after ADT completion as well. A post-treatment low PSA level in the setting of a low testosterone has a different meaning than a low PSA in the setting of a recovered testosterone. It also gives you a potential explanation for a slight temporary P...
How would you approach a morbidly obese patient with early stage favorable breast cancer who is premenopausal?
Yes, if favorable phenotype, would do APBI.
What is the most efficient way to contour small and large bowel?
MIM has a very user friendly and I like airplane mode. In general, it can be sometimes difficult to determine small from large bowel but if there is air, it is usually a sign that it is large bowel and if it is only liquid, usually small bowel. The terminal ileum sometimes has air in it, and the col...