Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is it safe for a patient to breastfeed during their course of EBRT?
Not aware of any concerns. In our pregnancy-associated breast cancer patients, I encourage women to breastfeed on the side I am not treating as long as med onc has cleared them. We work with pediatricians to ensure that the infant is reaching normal weight/growth milestones, but may need to suppleme...
Would you consider salvage radiation in a recurrent prostate cancer with a positive pelvic node and high inguinal node on PET/Axumin, but negative inguinal biopsy?
I would treat this patient as having oligometastatic disease to the nodes, similar to the more common scenario of finding 1-3 para-aortic nodes beyond a typical pelvic XRT field.Assuming no prior radiation to these sites, I would try a VMAT plan as long as skin constraints are met for the inguinal s...
Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors for COVID-19?
As per FAQ’s posted by ASTRO: There is no reason to do so at this time. Be vigilant re: hand hygiene and wiping down any equipment that touches the patient (stethoscope, etc.). Additionally, any equipment that touches mucosa/secretions of the patient must be sterilized (rhinolaryngoscope, etc.). For...
Would you give abiraterone in the post-prostatectomy setting to patients with positive nodes detected at surgery?
This clinical scenario of N1 but resected disease post-RP represents an area where there is not sufficient evidence to recommend abiraterone or any potent AR inhibitor. While there is evidence to support ADT in this adjuvant setting for N1 resected patients based on the older Messing ECOG trial, sim...
Does your recommendation for ADT change in an elderly patient with dementia and high risk prostate cancer?
Thank you for this question. There have been publications that have shown the association of ADT and cognitive decline. Probably one of the most robust studies was published in 2017 (Nead et al., PMID 27737437) in which the effect of ADT on dementia risk was assessed using propensity score-matched m...
How do you measure the skin dose when you are concerned about dosing to the skin?
We use diode.
Is APBI appropriate for patients with rare tumor histology (mucinous, medullary, or tubular) if they meet all other suitability criteria?
If phenotype right then it is tubular and mutinous are ER positive low grade tumor and are good candidates for APBI.
In what scenarios would you include the ventricles in your CTV for treatment of high grade gliomas?
I would not cover the ventricles prophylactically in any scenario. If you are concerned for involvement of the ventricles, then you have to think there's a high chance of CSF spread. In that case, you might want to consider whole brain RT.
How does avascular necrosis of the femoral head affect definitive radiation to the prostate?
I asked the question and have no long-term follow-up to draw on to answer it. For what it is worth, I will summarize below what I learned from discussion with one experienced orthopedic surgeon, plus some reading. If others have insight/comments/opinions, please share! AVN is irreversible. Risk fac...
Is there a reliable way to distinguish a metastasis from a secondary primary tumor if the histology is the same?
This issue may arise when a single lung lesion is found in a previously treated HNC, where distinguishing between a small secondary lung sqcca vs metastatic HNC have significant implications. A comparison of typical molecular characteristics in the primary and the secondary is a possible way. For ex...