Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you routinely prescribe vaginal estrogen therapy post chemo/XRT for female patients finishing anal cancer treatment?
No. We encourage all female patients to use a vaginal dilator and Replens over the counter vaginal moisturizer (vitamin E, B, non-hormonal) after chemoradiation. We also encourage patients to see their gynecologist to discuss topical estrogen therapy. There are potential side effects/drug interacti...
Would you recommend surgery or radiation for newly diagnosed localized prostate cancer diagnosed on a urethral lesion biopsy?
I think the underlying question here is whether its urethral location changes the recommendations we would otherwise make, and really it doesn't. Let's talk it through: I don't feel that the urethral location affects my ability to treat this with EBRT as the urethra gets the same (curative) dose as ...
Would you add dose/fractions to a post-mastectomy patient who had a two week break due to being COVID-19 positive?
There are no data on how treatment breaks impact the effectiveness of PMRT. I doubt a two-week break has a substantial impact in the era of effective systemic therapy, particularly if hypofractionation is used. Having said that, I do tend to add 1 or 2 fractions when there is a treatment break or br...
Would you use inhaled steroids with or without oral steroids for the treatment of radiation pneumonitis?
I have not tried inhaled steroids instead of oral steroids for symptomatic radiation pneumonitis much in my practice. Many patients are already on inhaled steroids at baseline, and many who develop pneumonitis have severe symptoms. That being said, avoiding oral steroids could be particularly import...
Do you treat the elective pelvic lymph nodes up to the common iliac bifurcation per the NRG Oncology Updated International Consensus Atlas?
Sentinel lymph node mapping studies show that the prostate’s lymphatic drainage does include the common iliac lymph node group establishing a rationale for its inclusion into the field definition. Corroborating evidence from a modern surgical trial employing extended pelvic LN dissections also suppo...
Is it ever appropriate to de-escalate regional nodal coverage in PMRT for patients with localized inflammatory breast cancer (IBC)?
At this time, I would still use full nodal coverage for all inflammatory breast cancers regardless of responses to neoadjuvant chemotherapy. I cover dissected and undissected axilla, SCV, and IMN.
When planning a moderately hypofractionationed treatment for prostate cancer, do you recommend using a bladder volume dose constraint?
We aim for 70 Gy < 10 and 35 Gy < 40 - 50 and try to avoid hot spot in bladder trigone region.
Do you consider post-operative radiation therapy for pancreatic neuroendocrine carcinoma?
In collaboration with @Dr. First Last, MD, Northwell Health Radiation Oncology Resident The first and most important point is that there is no clear level I or even prospective evidence to inform the use of radiation therapy for pancreatic neuroendocrine cancers, and it is unlikely that there will b...
Are there any circumstances in which you would recommend adjuvant chemoradiation for resected olfactory neuroblastoma?
Agree with Dr. @Dr. First Last. Our experience treating 29 patients with Kadish B and C neuro esthesioneuroblastoma with local RT if positive margins, and no neck RT when the neck was N0, resulted in 27% neck failure including in the contralateral neck. 5-year LRF rate was 29% in patients who did no...
At what PSA value do you obtain molecular imaging in a post RP patient with previous salvage prostate bed radiotherapy?
The answer to this question will strongly depend on what you intend to do with this information. If you have a patient with a very slowly rising PSA, say a doubling time of years, this patient may not benefit from any treatment so you may want to continue to observe them without any further testing....