Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you hold off on whole brain radiotherapy for a patient with metastatic NSCLC and multiple asymptomatic brain metastases and will be starting immunotherapy?
This is a very controversial area right now (as are most MedNet queries!). Given the data available and the opinion pieces by thought leaders right now on immunotherapy results in melanoma brain metastases, it would be very reasonable to hold off on WBRT for patients with asymptomatic melanoma brain...
How do you manage pelvic pain and hematuria due to recurrent high grade transitional cell bladder cancer who had received 70 Gy to bladder and is not a chemotherapy or surgical candidate?
It depends whether these symptoms are caused by radiation, recurrence, or both. One might not be able to distinguish. For hematuria I think a cystoscopy and focal fulguration if that is available to the patient, or else consider hyperbaric oxygen therapy, which may also improve pain (I don’t think h...
Would you skip adjuvant RT in post prostatectomy patients?
I suspect that once the paper is published and we get a chance to review the data that we may begin to hold off on routine use of adjuvant RT for prostate cancer patients after radical prostatectomy with higher risk features. That said, it should be noted that the study did randomize to early salvag...
How would you manage a patient who received neoadjuvant CRT per the CROSS trial for esophageal cancer, but refuses surgery after imaging shows a good radiographic response?
That's a great question. It is not evidence based, but with carbo/taxol (CROSS approach), I sometimes will go to 50.4 in case this very situation occurs. It's very well tolerated with conformal approach (the study treated with 41.4 Gy with AP-PA fields). If it has already happened, and too much ti...
How would you manage a patient with oligometastatic colon cancer status post resection of the primary whose single unresectable liver lesion has had a complete response to FOLFOX chemotherapy by PET?
This could be a pathologic complete response, so I would observe and recommend hepatic directed treatment if it progressed. If this were solitary nodule still, surgical resection would be the treatment of choice, followed by thermal ablation if feasible, and SABR (100Gy BED) is the third choice beca...
Do you use bolus for the lumpectomy cavity boost when the seroma is within 5mm of the skin?
I agree with the above that this is very rarely necessary. When it is required, it may be hard to define where the bolus is to be placed on an intact breast. One neat trick is to have dosimetry create an en face setup field with an aperture equivalent to where you want the bolus to be (cavity plus m...
How do you approach the work up and surgery for H&N SCC of unknown primary?
CT max, face, neck and chest. PET is ok but has a high false positive rate in the oropharynx where the primary is likely located in the US. Direct laryngoscopy and ipsilateral tonsillectomy. Bilateral tonsillectomy is ok but low yield (less than 5%). Biopsy base of tongue. Lingual tonsillectomy is o...
Do patients with Stage III unresectable NSCLC with lepidic features require a different approach to chemo-radiation?
Would you recommend salvage RT in a patient who previously had prostatectomy for high risk prostate cancer who is no longer tolerating his intermittent hormonal therapy?
Why was hormone therapy started. BCr or adjuvant ? if adjuvant doesn’t need any treatment and just psa surveillance
Do you offer ADT in patients with intermediate risk prostate cancer who receive hypofractionated EBRT?
There is no good evidence that with different radiotherapy dose/fx or other RT modalities that the relative benefit of ADT is any different. This applies also to SBRT, brachy, and combo-brachy. The basic evidence and logic is as follows:1. ADT improves MFS and OS in multiple RCTs using lower dose co...