Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you dose escalate a patient with high risk prostate cancer who refuses ADT due to potential side effects?
I would treat the elective pelvis to around 50 Gy with a simultaneous boost to the LN to as high as tolerable based on proximity to the bowel. The prostate should be taken to normal dose-escalated levels depending on your fractionation, and you can add a microboost to a DIL. I generally do not add a...
Is polymyalgia rheumatica associated with increased toxicity for lung SBRT?
No data here that I can speak to. Lung involvement is exceedingly rare in PMR and generally, I wouldn’t consider this a disease associated with increased risk of inflammatory response within the lung parenchyma. There are some reports of associated GCA, BOOP, and other interstitial lung findings in ...
What is your approach for treating oligometastatic head and neck cancer to an adjacent nodal site (ie. axilla, mediastinum etc.) with radiation therapy?
If limited chemo RT with curative intent.
Would you hesitate to give breast radiation to a patient with prior near-fatal Stevens Johnson medication reaction?
Although this is an extremely rare occurrence when looking at the literature on this subject, limited to case reports/series, I think that I would hesitate to give breast RT in this case. This is based on the fact that in this case, it is DCIS that is being treated, and despite the DCIS being recurr...
Is there a time interval after which you would not offer adjuvant radiotherapy for a malignant, grade 3 meningioma?
Adjuvant radiation for grade 3 meningioma is based on prior observational studies that generally reflect recurrence rates approaching 90% for grade III disease, and the insufficiency of salvage treatment approaches.Given the small numbers of grade 3 tumors, and the heavy bias towards upfront postop ...
When, if at all, do you use nasolacrimal duct stents to prevent stenosis/obstruction when treating skin, sinonasal, or other mid-facial H&N cancers with radiation therapy?
I don’t because when the stent is removed, the duct stenoses.
In a patient with history of successfully treated locally advanced H&N cancer, how do you discern between a metachronous second primary locally advanced lung SCC vs. metastatic head and neck SCC?
Solitary, particularly long interval, N0-N1, treat like lung primary. Multiple lesions, short interval, advanced neck disease, likely metastases.
Would you offer adjuvant chemotherapy after SBRT for biopsy proven sub centimeter metastatic pulmonary nodule from rectal cancer?
This is a great question and a common scenario we met in the clinic. First, we need to know more about the case, for example, if the patient has synchronous metastatic disease or it is metachronous metastatic lesion; if the patient had neoadjuvant/adjuvant chemotherapy; how long of the disease-free ...
Do you recommend ADT for a patient with hypogonadism with unfavorable or high risk prostate cancer whose PSA dropped to <1 after cessation of supplementation?
When I encounter this situation, I will measure the testosterone level off supplementation. If the testosterone is castrate level (<50 ng/dL), then I would not add ADT, as the target testosterone level has already been achieved. If the patient's testosterone level remains above the castrate threshol...
How would you manage a treatment-naive patient who has painful vertebral lesions from ES-SCLC?
ES-SCLC is incurable. If they are in pain, treat their pain. Chemotherapy is palliative. TRT may extend life, but the average life expectancy with ES-SCLC is limited. Don't let patients in pain suffer when we have an effective way to treat them. I would consider very short courses - 1-2 fx SBRT (per...