Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a patient with a low grade Follicular lymphoma and Gleason 6 adenocarcinoma of the prostate?
There are too many unstated particular clinical parameters to provide a specific answer to this question, but general principles are that neither of these malignancies necessarily require intervention. The very long natural history of each condition should guide us. Stage, symptoms, functional statu...
Does the presence of ductal adenocarcinoma change how you risk stratify or treat patients with localized prostate cancer?
Ductal adenocarcinoma (DAC) of the prostate is a distinct, but rare (< 1%) subtype of prostate adenocarcinoma. DAC originates from primary periurethral prostatic ducts or in the peripheral prostatic ducts. Because of its predominantly periurethral location, it may present with hematuria, urgency, an...
Are you treating with the superoxide dismutase mimetic Avasopasem (GC4419) for patients receiving chemoradiation for head & neck cancers?
This drug is not yet FDA-approved. It is currently under review by the FDA. I plan to use it after it is approved.
Do you have a preference between using 2 dose levels (5940/6996) versus 3 dose levels (5700/6300/6996) for NPC, EBV+ and why?
These are unfortunately, questions don't that get studied in our field. For whatever reason, the "low dose" for NPC on the RTOG 0225 study is 59.4 Gy and to have doses "around" that (57 Gy and 63 Gy) doesn't seem to add much value. I have transitioned away from 3 RX's to 2 RX's now for the majority ...
What adjuvant therapy would you recommend for a patient with a sarcomatoid carcinoma of the submandibular gland after R1 resection?
Postop RT
How would you approach an adult patient >50 years old with an intermediate risk extremity T2N0 fusion neg rhabdomyosarcoma who is progressing on neoadjuvant chemotherapy with VAC?
In the event of disease progression on chemotherapy, it would be advisable to re-examine the pathology of the patient to determine whether the patient has pleomorphic rhabdomyosarcoma, which is a subtype of adult rhabdomyosarcoma. If this is the case, treatment should follow the NCCN guideline for h...
Is there a role for radiotherapy to the primary in high volume metastatic prostate cancer with well controlled disease on ADT?
Yes, for some patients. Recent evidence supports an emerging role for prostate RT in the de novo high volume mHSPC population with the goal of preventing serious and symptomatic events from local disease progression. A 2023 update of STAMPEDE arm H demonstrated a significant reduction in the 5-year ...
For a patient with adenosarcoma of the ovary with high grade sarcomatous overgrowth removed intact with appropriate oncologic surgery, is there any role for radiation?
I don't see a role for adjuvant RT in this case. Should she develop a pelvic-only recurrence, then RT would be an appropriate modality.
Do you ever utilize short-course radiation when lateral pelvic (extra-mesorectal) lymph nodes are involved?
My general preference is to use long course chemoradiation for patients with involved extramesorectal/lateral lymph nodes as it is a relatively strong risk factor for pelvic recurrence and such lymph nodes are not routinely surgically resected. While the pre-TNT era randomized trials comparing short...
How would you treat the primary site of an adenoid cystic carcinoma of the floor of mouth s/p resection with positive margins with oligometastatic disease?
Postop RT and SBRT or resection of what would likely be a lung met.