Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend SBRT for an unresectable/unembolizable >10cm chest wall AVM with a diffuse nidus?
I would not recommend SBRT for this patient. Not sure if SBRT is indicated for any chest wall AVM. I think you could extrapolate from CNS and assume there could be some efficacy but there isn’t any good data that I’m aware of that SRS would help in this scenario. Moreover based on CNS AVMs, fraction...
Do you offer chemoradiation for de novo oligometastatic esophageal cancer after chemotherapy with no progression?
It is unclear if this is useful especially if asymptomatic from the primary/metastatic sites. The question is being assessed by ECOG/ACRIN in an ongoing randomized trial. The schema may be helpful. https://clinicaltrials.gov/ct2/show/NCT04248452
How do you treat localized prostate cancer with neuroendocrine differentiation?
Most hybrid or pure NEPC tumors lack PSMA expression as only 1/3 of metastatic NEPC tumors are PSMA PET+ and expression is typically very heterogeneous. For this reason, an FDG PET/CT would likely be a better staging test for this aggressive variant of prostate cancer. If this is also N0M0, RP is my...
Is prior prostate SBRT a contraindication to hemorrhoidal banding?
I would agree that there isn't a basis for a blanket denial of doing banding or other anorectal procedures to address QoL issues after prior prostate RT. There is, of course, a significant literature for argon laser, cautery, formalin, etc for radiation proctitis, and so if mucosal interventions are...
Would you consider short course radiation therapy for rectal cancer following APR?
No.
What is the rationale for 6 hours between EBRT and HDR fractions for BID treatment?
Based on half-life of repair of about 1.5 hours for most normal tissue (spinal cord is one of the exceptions). So 6 hours will be 90% repair with 4 half-life intervals.
Do you recommend that patients undergoing radiation treatment get a COVID vaccine booster?
Yes, we are recommending the third dose booster for our patients who are moderately or severely immunosuppressed. In addition to anyone getting chemoradiation, I would consider anyone treated with large field radiation to begin that category. As for timing, would start before treatment ideally. As f...
Will you consider adding an AR targeted agent to ADT for a patient thought to have isolated pelvic nodal recurrence of prostate CA if next generation imaging reveals additional non-regional disease not seen on conventional imaging?
There are no formal prospective trials addressing the question of timing (i.e. initiation of systemic therapy) based on metastasis identified on molecular only imaging. The best data available is based on the three trials in non-metastatic castration-resistant prostate cancer (PROSPER, ARAMIS, and S...
Does multiple myeloma become more radioresistant post transplant?
Anecdotally, I had a recent myeloma patient who developed progressive chest wall disease after ASCT and numerous prior rounds of therapy. I gave him 8 Gy in one fraction to two chest wall sites; one had a partial response before progressing months later, the second site progressed through RT with no...
What is your approach to the management of hot flashes in a patient who wants to use herbal medicine?
Hot flashes are so bothersome to some postmenopausal women, especially those with breast cancer in whom we discourage the use of estrogen or potentially estrogenic, that we now have evidence from randomized trials to help guide treatment. With regard to nonprescription therapies, data thus far suppo...