Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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 ...
Is there a benefit to EBRT for recurrent solitary fibrous tumor/ hemangiopericytoma in patient with multiple sites of intrapelvic recurrence?
Thank you for this question. Solitary fibrous tumors, as you know, are quite rare and the mainstay of treatment is surgery if feasible. The role of adjuvant (or definitive) radiation and/or chemotherapy has been used sporadically and thus has not been well established.In this case, if there are a re...
Do you do neurocognitive testing before giving PCI or any time thereafter?
This is an interesting question and I don't routinely do it, but I think the bigger question is what do you do with that data once you have it. One could argue it both ways and it brings in questions of quality of life and ethics in many ways. Is it better or worse to give PCI to a patient with low ...
Given the superiority of ADT+enzalutamide over ADT alone demonstrated in the ARCHES and PROSPER trials, would you recommend it in the definitive setting for men with high-risk castrate-sensitive prostate cancer?
The quick answer is: No.There is no level 1 evidence that next gen AR-signaling inhibitors (ASI) improve DMFS or OS in high risk localized prostate cancer. Multiple trials are ongoing or maturing in followup, nearly all in combination with RT.Given that most contemporary high risk studies show ~10% ...
Would you recommend surgery +/- adjuvant XRT or definitive XRT in elderly patients with recurrent squamous cell carcinoma of the ear with direct invasion through the cartilage of the helix?
It depends on co-morbidities and functional outcome of surgery. Preferably surgery and postoperative radiotherapy. However, if surgery is not in the cards, radiation alone to 70 Gy in 35 fractions or the equivalent using altered fractionation.
What doses would you treat the primary and lymph nodes in node positive vulvar cancer patient with incidentally found focal SCC in a field of VIN3?
I would treat the primary and inguinal nodes if no additional surgery and SNLN planned. Dose to primary is a function of microscopic or macroscopic disease left behind: 54-56 Gy if microscopic but 60 or above if macroscopic.
What dose constraints would you use for head and neck SBRT in a previously untreated field?
The use of SBRT as a primary modality in patients who have not undergone previous irradiation and are not felt to be candidates for surgery or definitive chemoradiation varies institutionally, with some preferring to treat with hypofractionated regimens (particularly when they are candidates for che...
Would you offer PMRT for cT2N0 triple negative breast cancer s/p NAC and mastectomy with residual disease and no positive lymph nodes?
We need more data. For microscopic residual have not been offering it but if there is residual disease more than 2 cm, we would consider the patient for PMRT.