Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for PORT in a N1+ NSCLC patient who refuses chemotherapy after lobectomy?
A few caveats to consider - is the patient refusing adjuvant chemo, or are there competing risks (cardiac, age etc) that may attenuate the absolute benefit of adjuvant chemo?EGFR / ALK status ? PD-1/PD-L1 status? (there are adjuvant trials evaluating other systemic options)In the absence of other op...
Would you do SRS for a patient who cannot receive gadolinium contrast and has a single brain metastasis on non-contrast MRI?
There is a reasonable concern that other small brain metastasis could be present without obtaining fine cut T1 imaging with gadolinium contrast. As long as the patient is otherwise a reasonable candidate for radiosurgery, and can return for follow up, I would feel comfortable going ahead with SRS ba...
When a patient with stage IIIA NSCLC is treated with induction chemotherapy alone followed by surgery, and has a pCR, do you offer post-operative RT based on pre-chemo findings or omit due to complete response?
This issue comes up regularly....the assertion being that if the mediastinal disease has been cleared with chemotherapy, there is no need for RT. However, studies have shown that local failure is still quite high even when a mediastinal pCR is achieved. In the SAKK trial (B Journal of Cancer 2006;94...
What do you use for post-treatment follow up for prostate cancer patients whose cancers make little to no PSA, such as very high Gleason grade/neuroendocrine tumors?
We can probably separate the question into two categories: the rare prostate cancers that make absolutely no PSA and those that make relatively little PSA. For those that make zero PSA, then I've generally followed them with imaging similar to how one might follow a small cell cancer of any primary ...
How do you manage multifocal glioblastoma or high-grade gliomas?
In multifocal glioblastoma or high-grade gliomas, I would consider surgical resection if there was a dominant lesion or lesions causing symptoms. In cases where debulking is unlikely to provide symptomatic relief or aggressive surgery is most likely to remove a portion of disease burden, I would ten...
Would you consider concurrent chemoRT for unresectable bladder adenocarcinoma?
The simple answer is YES. If unresectable then follow the established treatment paradigm of maximal TURBT followed by ChemoRT. Platinum based regimens are typically the standard with good evidence for alternative schedules such as 5FU/mitomycin or Gemcitabine (low dose). This is s potentially curati...
Do you prescribe prophylactic steroids with spine SBRT?
I do not use prophylactic steroids for spine radiosurgery. I indeed start tapering steroids from the time of consultation if the patient was already on steroids. After radiosurgery of spinal cord compression, I start tapering on the day of radiosurgery.Pain flair seems to occur in 10-20% of patients...
How do you handle the situation where a curative-intent patient unexpectedly passes away while under treatment?
As many of the patients we treat are older and have numerous co-morbidities, this is not that rare an occurrence. Of course, we would presume to avoid treating patients with curative intent if it is readily apparent that their life span will be short due to other non-malignant illness. That said, I ...
Is SBRT appropriate for a small endobronchial tumor distal to the proximal bronchial tree?
In my opinion, you can approach them like any other peripheral NSCLC. There are challenges with small tumors in terms of finding them on CBCT sometimes and getting the dose in if they are very small. The 0236 protocol mandated a minimum aperture of 3.5 cm, which made it not very useful to treat tumo...
Does p16 status (HPV) influence your decision on whether to offer adjuvant chemoradiation or radiation in node positive H&N cancers?
No, p16 status should not influence the decision for initiating adjuvant therapy as p16+ patients have similar risks for failure after surgery as p16- patients without adjuvant care. Whether these patients may receive de-escalated therapy as part of a clinical trial is a separate question from wheth...