Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage simultaneous muscle invasive bladder cancer and intermediate or high risk prostate cancer in a patient who refuses surgery?
When I'm faced with a situation like this, with 2 concurrent pelvic malignancies, I like to think about how I would manage each one independent of the other and then try to design a plan that incorporates management principals of both diseases. You also have to consider how treating both concurrentl...
How do you counsel a patient on treatment with SBRT/SABR vs. thermal ablation in the setting of early stage NSCLC or lung metastases?
This is an important question that arises in tumor boards and other multidisciplinary discussions (despite what I feel is accumulating evidence that SBRT offers better control and survival). Our colleagues in interventional radiology continue to offer improved technology, and the equipment vendors s...
Would you consider nodal irradiation alone (not irradiating chest wall) in an otherwise early stage breast cancer, cN0 patient but has a positive node from a SLN bx who is status post mastectomy?
Though the presence of nodal disease is used to help identify women that benefit from adjuvant radiation treatment, patterns of failure data support that the majority of recurrences occur on the chest wall. Therefore if there are indications for nodal treatment (such as those noted above), I would p...
How would you manage a hemangioendothelioma with brain invasion s/p partial resection?
Hemangioendotheliomas are extremely rare, mostly benign but sometimes malignant, tumors of endothelial blood vessel cells that exist on a spectrum of aggression somewhere in between hemangiomas and angiosarcomas. Guidelines for their treatment are garnered from small case series and case reports. R...
Is there a role for radiation in the treatment of bulky axillary adenopathy in patients with newly diagnosed oligometastatic melanoma?
This is an interesting and multifaceted question.The patient has oligometastatic disease, suggesting that other sites are involved but less than 4 or so more. Surgery for cure should be considered. Rates of recurrence increase rapidly with number of metastatic sites. If surgery is to be done, comple...
How do you define your partial breast volumes when doing partial breast irradiation?
I think this depends on technique (3D-CRT), motion management, and image guidance.For standard 3DCRT APBI, you can use B39 volumes or IMPORT LOW. I rarely do this as these volumes are quite large.However, if you are going to use motion management (4DCT, DIBH) you can create an ITV or limit your expa...
When a large malignant appearing GI mass is encountered on endoscopy but biopsies show dysplasia or carcinoma in situ, would you recommend additional biopsies or proceed with treatment for invasive cancer?
This is an issue that comes up fairly regularly. The simple answer is that we should not treat (with radiation or chemotherapy) without a cancer diagnosis, but life is rarely that simple and every rule has exceptions. Certainly, whenever possible, a repeat biopsy should be done, or, as @Dr. First La...
In a patient with gastric adenocarcinoma with +peritoneal cytology status post an R1 resection, would you consider post operative chemoradiation?
Probably not. I generally don't see a role for adjuvant CRT in the setting of positive cytology, as locoregional recurrence is not likely to be the primary issue going forward. Of course every situation is individual, and one wonders how this patient ended up undergoing resection in the first place ...
Do you consider adjuvant radiation for low grade T1bN0 gallbladder adenocarcinoma with negative margins after oncologic resection?
There are no data to support chemotherapy and especially not postoperative radiation.
What factors affect your decisions in in the initial management of a stage IIIB bladder cancer?
For cN+ bladder Ca, I start with induction chemotherapy aiming for 4-6 cycles (restaging initially after 3 cycles and continue to 1-3 more cycles depending on response & tolerance) since the risk of micro-Mets is exceedingly high. If a patient has a great response to induction chemo, options may be ...