Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage muscle pain and irritation due to radiation?
One can start with NSAIDs. If it is not effective, one can proceed to use a Medrol Dose Pak or dexamethasone 4 mg QD. If it is pain flare, one can start with steroids.
Are cold spots on an external beam plan due to prostate fiducials concerning?
The dosimetry around fiducials is complex, with both some minimal shielding and increased dose due to scatter coming into play. Honestly, I'm not sure how accurate the planning system algorithms are in determining dose in the immediate vicinity around the typical tiny fiducial. On balance, I think t...
How would you treat an unresectable verrucous carcinoma invading the anal sphincter?
Would treat with same plan and intent as typical squamous cell cancer with chemo option being xeloda and MMC or xeloda and cisplatinum.
Would you consider radical prostatectomy for a young male with unfavorable intermediate risk cT3a prostate cancer and PSMA PET concerning for regional lymph nodes involvement but negative conventional imaging?
I would approach this scenario by considering two main issues. The first issue is what the probability of the patient truly having pN+ disease based on cN+ findings on advanced imaging. There have recently been two trials published from the Netherlands, PEPPER (using 68¸Ga-PSMA-11) and SALT (using 1...
Can adjuvant nivolumab for bladder CA as per Checkmate 274 be extrapolated for the concurrent chemoRT bladder preservation setting?
Great question. Short answer is no. Different scenario and very hard to extrapolate from the adjuvant post radical cystectomy setting. We need dedicated bladder preservation trials, e.g. S1806 and Keynote992. Recommend to accrue in those 2 large phase III trials for patients who opt for bladder pres...
Would you treat the pelvis in a high risk prostate cancer patient who is anticipating pelvic kidney transplantation?
My decision to treat pelvic nodes depends on the specific risk criteria present, but let's assume that this patient meets those criteria. In this situation, it is important to discuss the options for locating the vascular anastomoses with the transplant surgeon. Typically, these would involve either...
What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?
This is a challenge for our center, and many other centers as well. The ideal approach would be to have adult primary care physicians associated with our center who have dedicated clinic time to care for cancer survivors, direct access to our expertise and medical records. While we haven't been succ...
What target volume and dose would you boost for inflammatory breast cancer with prepectoral saline implant?
There is no defined boost volume and if has a poor response to chemo, would take tangential chest wall field to mid 50s dose.
For which head and neck cancer patients do you or your dental colleagues recommend fluoride?
DDS or I will prescribe Rx-strength fluoride toothpaste (1.1%, which is ~ 5X as many parts per million relative to commercial toothpaste) to all patients in whom we anticipate some degree of radiation-induced xerostomia (RIX). My general approach for most H&N patients in whom we anticipate RIX: Pr...
How would you sequence 177LU-PSMA-617 with current therapies for men with mCRPC?
I would like to congratulate the VISION study investigators and Dr. @Dr. First Last for the outstanding presentation and good news. The study was designed to use a hybrid control (best "standard of care"-SOC) and as such, it met its endpoints (OS, rPFS, etc). Secondary endpoints also significantly f...