Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What criteria does your institution use to indicate patient is ready for PEG tube removal?
The short answer is we typically advise patients that if they can maintain an oral diet (using the tube for flushes only) for 2 weeks and demonstrate no weight loss they are typically ready for tube removal. Our patients though are followed through the course of their treatment by a dietician, and t...
How would you manage a symptomatic marginal zone lymphoma of the base of tongue causing globus sensation also incidentally found to have squamous cell carcinoma in situ?
I would not irradiate a Stage 0 oropharyngeal cancer, much less irradiate the necks electively. But this is not just a CIS (TisN0M0 of the base of tongue) case; this is a very interesting/rare case presentation of what strikes me as a kind of Waldeyer's ring "MALToma" of the lingual tonsils. MALToma...
How do you approach hippocampal sparing RT in the setting of peri-hippocampal metastases?
Not unless there is a reason to do so.
How do you approach the treatment of synchronous primary pancreatic and base of tongue cancers?
There are probably many possible pathways here although none of them are ideal. If the patient has a BRCA 1/2 or PALB2 mutation, or even if not, they could start with Gemcitabine + cisplatin for the pancreas cancer which might have some activity against the base of tongue cancer. If there is a respo...
What dose constraints do you apply to the LAD for lung SBRT?
This is a great question and one that does not yet have a clear answer from SBRT toxicity outcomes data. Practically, I think we start with contouring the nearby coronaries (which is not such an easy task to broadly implement from a workflow standpoint!) and evaluating the low to moderate isodose li...
How would you manage a low risk patient with a negative fusion prostate lesion by biopsy but MRI shows apparent advanced disease?
Assuming that the patient has NCCN low-risk features and MRI findings of EPE (which is the most common situation), I would think about this situation in two different subcategories: (1) active surveillance (AS) is still under consideration, and (2) the patient has decided he would like to proceed wi...
What is the earliest time to check PSA after prostatectomy?
The half-life of PSA in the circulation is about 3 days, so there is no point checking PSA within the first 15 days (5 half-lives) as any detectable PSA at that point may just represent residual PSA that has yet to be cleared. Most surgeons I have worked with generally wait 4-6 weeks, which should b...
Would you recommend upfront radiosurgery for trigeminal neuralgia caused by AVM abutment at the entry root zone?
Radiosurgery (SRS) at high doses to the dorsal nerve root entry zone is an effective treatment modality for primary or idiopathic trigeminal neuralgia (TN), but is significantly less efficacious when utilized for secondary trigeminal neuralgia, as caused by tumors, plaques, AVMs, etc. There are case...
What is your approach to postoperative radiation for intraductal carcinoma of the parotid?
I would consult a pathologist specializing in head and neck cancer. Low grade intraductal ca is similar histologically and clinically to intraductal ca in-situ of the breast, with myoepithelial markers and ductal differentiation, and requires surgery alone. On the other hand, high grade ductal carci...
How would you approach a patient with acute development of radiation changes around the target while undergoing a course of lung SBRT?
The answer to this question is dependent on the dose/fractionation of lung SBRT being employed. For example, at our institution, we preferentially use single fractions for peripheral lesions and for fractionated central dose schedules such as 50 Gy in 5 fractions, we do not gap the treatments but tr...