Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you determine the optimal duration of bevacizumab therapy for treatment of brain radionecrosis following SRS?
I would recommend enrolling patients on the randomized trial from Alliance, A221208 which randomizes patients to dexamethasone +/- bevacizumab. In that protocol, bevacizumab is given on days 1 & 15 of a 28-day cycle x 4 cycles.
How would you treat indeterminate non-PET avid sub-cm common iliac nodes in a patient with locally advanced cervical cancer?
It has to be interpreted with clinical context including stage of disease and nodal staging with PET. If multiple pet positive nodes in pelvis would treat with extended field up to renal vessels and boost any suspicious node as data suggest high risk of pa failure in these pts. If no pet avid node t...
What are your criteria for inclusion of the retropharyngeal LN in node negative H&N cancer patients?
I generally include lateral RP nodes in elective volumes for nasopharynx, oropharynx and hypopharynx tumors and any H&N tumor that has invaded into pharyngeal wall/soft palate. Also should consider inclusion in elective volumes for treatment of hard palate / nasal cavity / paranasal sinus primaries....
What is the utility of a biopsy in the setting of an elevated post-prostatectomy PSA and imaging noting a local prostate bed recurrence?
It would generally be reasonable to treat an imaging detected prostate bed mass without a confirmatory biopsy if one was going to treat the patient whether the biopsy was positive or negative. Some radiation oncologists are escalating doses to higher that standard levels in the postoperative setting...
Would you recommend PMRT in a patient with dermal invasion as the sole adverse feature after a skin sparing mastectomy for an early stage breast cancer?
Pathological dermis involvement in these early stage patients is function of location ( like retroareolar or superficial location) rather than aggressiveness of disease and thus outcome is more like early stage disease In absence of other adverse factor I would favor observation
Would you recommend observation in an elderly patient with an ER positive, early stage breast cancer who has a high risk Oncotype Dx score?
I would not favor observation in high oncotype Dx as is it is a risk factor for high local relapse (based on NSABP where it showed higher risk relapse even after lumpectomy and RT, although risk was higher in younger vs. older).Even in PRIME 2 high grade was associated with higher risk of relapse wi...
What types of sexual side effects do you discuss with men undergoing radiation therapy for rectal and/or anal cancer?
This is an excellent question as the literature is pretty clear sexual side effects of non-gynecologic or prostate cancer therapy are often omitted from discussion before therapy or in follow-up. Consequently, there is limited data on sexual dysfunction for rectal or anal cancer survivors. The studi...
What imaging surveillance do you do after SABR of oligo lung metastases?
Since these are metastatic patients I would recommend chest CT scans every 3-4 months for the first and second years. Abdomen and pelvis CT scans could also be done depending on the patient and their disease. I do not recommend PET-CT after SBRT for lung metastases or after SBRT for lung primaries. ...
How do you counsel patients in regards to the options and risks for salvage lobectomy/wedge after SBRT?
For early stage lung cancer, we discuss with our patients the surgical and nonsurgical options, and provide the rationale for our recommendation. A common question is whether the patient can have surgery if the SBRT doesn't work. I think SBRT patients need to know two things relating to this questio...
When do you consider neoadjuvant chemotherapy prior to definitive chemoradiation for cervical cancer?
Although we are occassionally referred patients for "consolidation" of loco-regional disease after favorable responses to chemotherapy for stage IVB disease, we very rarely give neoadjuvant chemotherapy for patients with stage I-IVA cancers with nodal disease confined to the pelvis and PA regions. E...