Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the optimal duration of ADT for cN1 disease with EBRT?
Unfortunately there are no prospective data to guide management for cN1 prostate cancer treated with EBRT. The NCCN guidelines do not comment on the optimal duration of ADT in this setting. While 18 months may be considered for some patients with high risk cN0 prostate cancer as per the PCS IV trial...
How would you manage a resected meningioma found to harbor a small focus of metastatic disease from a non-CNS primary malignancy?
Mets to a tumor (Collision) are seen, though rare. Simple answer: 1. Meningioma resection (Grade 1) or for that matter up to Grade II, irrelevant since the time to progression in a less than a Simpson Grade I resection would far outrun the metastatic cancer. 2. Treat the resection cavity like a met ...
How would you approach local recurrence of scalp angiosarcoma during the course of adjuvant radiotherapy after a widely R0 resection?
I've had similar. I had to cover the entire scalp using tomotherapy as tumor progressed when I wasn't looking. We treated with concurrent taxanes as there was a suggestion in the literature to do this and had a reasonable response. Suggest you resimulate and patch treatment fields.Try this article: ...
What are indications for RT coverage of pleural cavity for margin positive resected Askin tumor after neoadjuvant chemotherapy?
Patients with malignant pleural effusion, pleural violation (2/2 chest tube placement through tumor) or pleural nodules at diagnosis should be considered for whole-pleural surface RT at the time of local RT to the chest wall. Of note, patients w/out + margins would also be considered for whole pleu...
Given in RTOG 9601 that patients who had a pre-RT PSA <0.7 did not derive a survival benefit with ADT, why was other cause mortality evaluated in patients with PSA <0.6 as noted in this year's plenary?
I am not sure the exact question as it could be interpreted as 1 of 2 things. 1. Was a different cutpoint used in the NEJM paper and in the ASTRO plenary? -No. The median PSA of the trial was 0.6 ng/mL. The NEJM used <0.7 (0.2-0.6) and the ASTRO plenary simply used < or = 0.6 (0.2-0.6). Just a diffe...
How do you manage persistent tumors at the primary and/or nodal site for p16+ tonsilar SCC after definitive chemo-RT?
I would get a first PET-CT and CT with contrast (or MRI, if that was the better study pre-RT) 12-14 weeks after completion of RT/CRT. There are a number of studies on the optimal timing of PET/CT after treatment of p16+ cancers, including a case series published by my team: Wotman et al: 2019. In my...
In rectal cancer in patients receiving total neoadjuvant therapy of FOLFOX followed by 5FU-radiation, is there a role for additional adjuvant chemotherapy based on significant residual disease at time of surgery?
To my knowledge, there is no known role for additional adjuvant treatment in patients with rectal cancer who have received total neoadjuvant therapy with FOLFOX followed by chemoradiation or short-course radiation (SCRT). As of yet, no clinical trials address this situation. Furthermore, there is no...
Is it common to have atypical squamous cells on pap smear s/p chemoradiation for anal cancer in a female?
Yes. That's why women with anal cancer should have PAP smears before radiation. I am unsure as to the duration of these changes. My pathologist friends say a few months.
Would you offer palliative radiation therapy for bleeding risk reduction in a patient with large vessel invasion from an intrathoracic tumor who requires anticoagulation?
Hi. Based on what you present here..."Exsanguinate" comes to mind for me in this instance. I can recall one lung ca patient who had such a final event early in my career. And I have seen some in-patients with advanced Head Neck cancers go out that route. It can be quite disturbing to some / unsightl...
Would you consider radiation therapy for ovarian dysgerminoma with residual lymphadenopathy after chemotherapy?
I would not as behavior like seminoma and most of the time turns out to be a desmoplastic reaction. You can consider a PET/CT as it has high negative predictive value. But if pet positive, it could be false positive and would monitor with serial imaging rather than treat and, if needed, consider for...