Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When treating an inoperable patient with squamous cell carcinoma of the thoracic esophagus, do you ever dose escalate beyond 50.4Gy?
Given the results of INT-0123/RTOG9405 failed to demonstrate an improvement in overall survival with dose escalation, I do not treat above 50.4 Gy when giving definitive chemoradiation. There is no other randomized evidence to support doses greater than 50-50.4 Gy at 1.8-2.0 Gy/day.Patients treated ...
Would you consider treating elective cervical nodal volumes for a highly invasive pituitary adenoma with high-risk features?
I think this depends on what is considered high risk. In general I do not routinely cover cervical lymph nodes. I’d take into account the size, functional/secretory status of the tumor, and whether pharmacological/surgical options have been pursued.
What is your preferred palliative regimen for pancreatic cancer with pain related to celiac plexus involvement?
I prefer to use 36Gy in 12 fractions, which can be given AP/PA as long as it is homogeneous. Even though the GI rad onc academic community promotes SBRT techniques for palliation, the use of an SBRT technique in this setting is unnecessary for such low doses. I only use an SBRT technique when I woul...
Would you recommend hypofractionated treatment for early stage, bilateral breast cancers?
yes as i don't see any reason and have done multiple times
In which patients do you prescribe Marinol?
The short answer to this question is I prescribe dronabinol to patients who are requesting medical marijuana but don't have a state-issued medical marijuana card yet. It can take 2-3 months for Illinois to issue the card (hooray for bureaucracy!) unless the patient is deemed "terminal" (i.e. <6 mont...
How long after high-dose IV methothrexate for chemo-refractory CNS lymphoma do you wait before giving brain radiation?
As was taught by my mentor- "As long as possible!". Of course, the prognosis is extremely poor if the patient is chemo-refractory to IV MTX and longer-term risks of WBRT may be less relevant than present-day symptoms requiring palliation. While I do recommend WBRT, as what is visualized on MRI is ju...
How would you approach a patient with locally recurrent esophageal carcinoma who is s/p previous chemoRT and refuses salvage surgery?
There is little data to guide treatment in this situation and well founded fear of toxicity with repeat radiation. In a recent report from China, patients with locoregional recurrence after definitive treatment that involved RT had impressively longer OS with repeat RT to a median dose of 50 Gy. The...
Would you use standard neoadjuvant chemoradiation for a patient with advanced rectal cancer and a history of previous pelvic RT for another cancer?
No. We have to remember that the benefit of radiation in locally advanced rectal cancer is limited to a local control benefit; and must balance the risks/benefits as such. Moreover, there are T3 tumors with an uninvolved mesorectal fascia(1) where the role of radiation may be more limited; since a T...
How would the presence of active rheumatoid arthritis on methotrexate impact your choice of fractionation for a patient with prostate cancer?
It depends on the dose of MTX. For 7.5-10 mg weekly doses have not changed volume or dose but if on a higher dose of MTX then I would discuss with rhematologist for possible holding or decreasing dose of MTX (as in that range has known radiosensitizing effect)
Would you offer RT to a patient with a stage I low grade follicular lymphoma in the groin/upper thigh (7 cm) s/p complete excision with negative margins?
An abstract presented at the 2017 ASTRO from MD Anderson Cancer Center by Andraos and colleagues (last author Dabaja) addressed this question in a retrospective analysis. Of the 39 patients who underwent complete resection of their nodal low grade FL, "those treated with adjuvant therapy experienced...