Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer postoperative radiation for adrenocortical carcinoma?
I just answered a similar question asking about ACC s/p resection with a positive margin, but the same principles apply here: Adrenocortical carcinoma is a very rare entity, and it is associated with a poor prognosis. I have only treated a few. Despite aggressive resection, there is a high rate of l...
Do you recommend adjuvant XRT for adrenal cortical carcinoma s/p resection with a positive margin?
Adrenocortical carcinoma is a very rare entity, and it is associated with a poor prognosis. I have only treated a few. Despite aggressive resection, there is a high rate of locoregional failure. The data regarding adjuvant radiation after surgery are very limited, mostly small retrospective studies....
When do you initiate vaginal cuff brachytherapy treatment after hysterectomy for early stage endometrial cancer?
We usually start vaginal cuff treatment 5-6 weeks after hysterectomy. If adequately healed, may start at 4 weeks but not before. Rarely more than 8 weeks. For patients receiving vaginal cuff treatment plus chemotherapy, we still give cuff treatment within 6 weeks. There is no reason to delay because...
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What salvage EBRT dose would you recommend for radiation-naive patients with Hodgkin's Lymphoma who are refractory to chemotherapy and immunotherapy and decline to undergo transplant?
This is likely a palliative scenario, thus, I would try to limit toxicity and time spent on treatment. 30-36/3 appears reasonable, in my opinion.
Do you offer RT both to the prostate and synchronous oligometastases in de novo oligometastatic prostate cancer?
We do not yet have good evidence to tell us whether or when we should offer metastasis-directed therapy (MDT) for de novo oligometastatic prostate cancer. ORIOLE (like STOMP) was conducted in the recurrent setting. Those trials showed that MDT could delay progression and possibly allow a delay in th...
What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?
Dexamethasone is one of the most frequently prescribed medications in neuro-oncology clinics. Dexamethasone is often favored over other corticosteroids owing to its lower mineralocorticoid effects and high potency as well as essentially 1:1 oral to IV ratio meaning that we use similar IV and oral do...
When treating endometrial cancer patients with a combination of chemotherapy and vaginal cuff brachytherapy, when do you deliver cuff brachy?
I prefer, most of the time, between the cycles of chemotherapy (1 to 3) based on logistics.
What would be your radiotherapy plan for an overall stage IIA, low-lying, MMRd rectal adenocarcinoma to try to avoid APR?
For an MMRd rectal cancer, I would use immunotherapy! Very promising data from MSKCC suggesting upwards of 100% clinical complete response with dostarlimab alone, without the need for RT!
How do you approach rising PSA following radical prostatectomy and early salvage radiation therapy?
There are several factors that I will take into consideration, including the patient's overall health, the interval from treatment to relapse, the PSA doubling time (rather than a PSA threshold), whether or not they're castrate resistant and whether or not they now have overt metastatic disease. Pat...