Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your top takeaways in GU Cancers from ASCO 2022?
1. Bladder cancer. Potential new non-muscle invasive bladder cancer immunotherapy with N-803, an IL-15 superagonist plus BCG. Abstract 4508. Demonstrated striking complete and durable remissions (70%), bladder preservations over 1-2 years of follow up (>90% cystectomy free survival), favorable toxic...
Do you have particular recommendations for management of a nipple piercing during adjuvant breast radiation?
I have never had a case where this was an issue (i.e., piercing done during the RT). Nevertheless, I would consider this similar to any small wound (e.g. biopsy) within a site being actively irradiated. I certainly have done punch biopsies during chest wall RT and not do not recall having problems. ...
In patients with CML on imatinib and newly diagnosed breast cancer now requiring radiation therapy, should we hold imatinib?
I recommend continuing imatinib through the radiation. The time of imatinib is rather short and stopping poses a risk of CML coming back with the fact that molecular remission is iffy. Kanti Rai
How would you approach radiation to a thoracic tumor adjacent to an aortic dissection?
Address the aortic dissection and treat the tumor if the patient survives.
What adjuvant radiation modality would you select for a grade 2 endometrial cancer with small nodule in the fallopian tube?
She would get chemotherapy for stage IIIA disease. For RT, in the past, used to offer EBRT after chemotherapy but now, if surgically staged with nodal assessment, would favor brachy alone.
In metastatic/recurrent clear cell carcinoma with a solitary site of metastasis to the bone when, if ever, do you consider local therapy adequate and hold systemic therapy?
If I have a patient with a treated solitary metastatic site in RCC (bone or otherwise), I generally give local therapy and historically would not give systemic therapy. A point of discussion would be use of adjuvant pembro in this setting. While bone mets were not included in KEYNOTE-564 resected M1...
What protocols or safeguards do you implement if bed bugs are found on a patient or their belongings while on the treatment table or near equipment?
Typically once a bedbug is identified, the patient is brought directly into our inpatient holding bay so that there is limited time to contaminate common areas of the department. Therapists do utilize contact precautions including knee high shoe covers. We then have our hospital facilities team trea...
Would you treat a patient with metastatic castration resistant prostate cancer and prior treatment with Ra-223 with Lu-117-PSMA-617 therapy?
Yes, assuming they are otherwise eligible with PSMA + disease, acceptable blood counts, etc. In fact, in cases with patients with bone only disease, many argue to start with Ra223 rather than Lu117 as if they progress beyond bone only disease and are treated with Lu117, they will not be able to rece...
Do you offer adjuvant radiation for low grade spindle cell neoplasm of the breast after lumpectomy?
We need to qualify if it is benign or malignant phyllodes or some other sarcoma as the management principle is different. If is it low grade sarcoma, then can use the similar principle of sarcoma management and consider for adjuvant RT after lumpectomy (organ preservation approach).
How do you manage rectal or bowel perforation from interstitial brachytherapy needles?
One additional step I take other than the one highlighted is at the time of CT simulation if I notice that, I would pull those needles out either completely or to the point they are not into the wall of OARs.