Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you recommend prophylactic treatment of spinal metastasis(-es) after initial identification on staging imaging for a metastatic solid tumor?
The closest thing that I have done to prophylactic spinal (vertebral body) treatment would be if someone has a symptomatic spinal metastasis very close (within 2 vertebral bodies) that is going to have radiation treatment. I might include the asymptomatic one so that later there is less probability ...
Can hydrogel spacer be placed in a previously irradiated pelvis if considering prostate radiation by brachytherapy or SBRT?
The simplest answer to your question is “maybe”. Spacers have been placed in previously irradiated patients. You won’t know until you attempt to hydrodissect during the procedure.
What is your approach for a PMRT patient that cannot tolerate prone or supine sim with necessary arm positioning?
In terms of tolerating simulation following mastectomy, the most common issue I have faced is raising the arm. One option is to try a referral to breast therapy to assist with range of motion, cording as needed. If the patient is still unable to raise arm needed for prone/supine, as needed, I have u...
How should young patients with rhabdomyosarcoma be managed in the absence of a clinical trial?
The guiding principles of disease control while maintaining form, function, and quality of life drive the decision-making and management for patients with rhabdomyosarcoma.Regarding patients with paratesticular primary, inguinal orchiectomy with no scrotal invasion but tumor on the surface of the re...
How would you manage a premenopausal female with stage I triple positive breast cancer who is asymptomatic and tests positive for COVID mid way through radiation therapy?
I think there are a few options here: 1. Break the patient and resume when cleared per your institution's protocols. I typically consider adding a fraction for every 5 days of delay. So, if it is 10-15 days for example to when she is cleared, then add 2-3 fractions. 2. Continue to treat patients per...
In a patient treated with chemoradiation therapy for anal cancer 10+ years ago who presents again with localized anal squamous cell carcinoma, would you consider repeat chemoradiation for organ preservation instead of APR since so much time has passed since the first treatment?
Usually no, and APR would be the most appropriate treatment option once all factors are considered. However, for small localized tumors, brachytherapy for local control may be considered but discussion regarding sphincter control is paramount as it may be compromised post reirradiation.
How would you manage a locally advanced prostate cancer with positive pelvic nodes, incidentally found at the time of radical cystectomy for bladder cancer?
A growing body of retrospective data suggests a benefit to the addition of pelvic radiation in addition to ADT in men with node-positive prostate cancer. The decision to treat, in this case, has to be balanced by the competing risks related to the bladder cancer. If the patient's prognosis from the ...
How do you balance short-course ADT in unfavorable intermediate risk prostate cancer patients with cardiac comorbidities?
One paper that addresses the topic was published in the Red Journal in 2016 (Rose et al., PMID 27788950). This retrospective analysis attempted to answer the question of which patients would derive disease-specific mortality benefit from the addition of ADT. Patients included in this analysis were f...
When would you offer post-operative therapy to a resected non-melanomatous skin cancer with a solitary positive node?
I treat them all. If they are fit enough for surgery, their prognosis is good enough to treat.
When are increased flank doses beneficial in Stage III Wilms tumor?
The current standard of care in North America for radiotherapy dose in the treatment of Wilms tumor (WT) has been established by the National Wilms Tumor Study (NWTS)-3. This study randomized Stage III favorable histology patients to 1000 cGy vs. 2000 cGy as well as 2 drugs (actinomycin D and vincri...