Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat pleomorphic rhabdomyosarcoma in an adult?
Rhabdomyosarcoma is a rare malignancy, with ~350 cases annually in the United States, but most commonly occurs in children. Thus, adult rhabdomyosarcoma is exceedingly rare. As a result, there are very limited data on adult rhabomyosarcoma to guide treatment decisions and much is extrapolated from t...
How do you manage dry mouth after head and neck RT?
I think it is important to very clearly explain to the patient that xerostomia is common and even should be expected, even in the era of highly conformal treatment plans. If a patient is highly motivated to preserve saliva, pilocarpine can be used concurrently with radiation where it has been shown ...
For what patient groups (if any) do you routinely recommend screening colonoscopy prior to radiation for prostate cancer?
As a cancer care provider treating both GI and GU malignancies, I see this as a commonly. In many healthy men, an elevated PSA may be what allows them to "plug in" to the American health care system, often the first time in many years. Considering most prostate cancer is detected by an elevated PSA,...
How do you approach treatment for high-risk prostate cancer in patients who need clearance for organ transplant listing?
Our initial approach for these patients is to engage their transplant physician to understand the barrier for organ transplant listing. For some patients, the presence of a detectable PSA is the rate limiting factor, while for others having untreated disease is the main issue. The difference between...
How do you approach radiation treatment planning for prostate cancer in a patient with microscopic colitis?
It's been my observation that most radiation oncologists have a visceral reaction whenever thinking about prescribing ionizing radiotherapy to patients with any type of inflammatory bowel disease. As such, the idea of a prostatectomy in this situation typically emerges as the preferred option, with ...
How do you balance aspiration risks with encouraging PO intake for HN cancer patients during and after chemoradiation?
The main challenge is to identify the patients who are most prone to aspirate during and after Tx. Chemo-RT-related aspiration is frequently “silent”: the patient does not recognize he/she aspirates, and neither does the observer. The risk of aspiration is assessed by modified barium swallow perform...
Would you recommend hypofractionation in breast cancer patients who had partial mastectomy with significant oncoplasty?
In the absence of robust data suggesting that use of oncoplasty should alter whole breast radiotherapy recommendations, hypofractionation is our preferred approach following partial mastectomy with oncoplasty in patients without indications for regional nodal irradiation. According to 10-year follow...
In a patient with prostate cancer who developed prostatits after placement of fiducials, how long does one wait before initiating radiation treatments?
Prostatitis can be difficulty to clear, especially with the introduction of a foreign body into the infected organ (i.e., the fiducials). Also, the symptoms resulting from irradiating the prostate can mimic those of prostatitis, so I want to be as certain as possible that the infection has cleared b...
What is the rate of a cardiac events that you quote to a patient with preexisting heart disease going on trastuzumab for metastatic Her2+ breast cancer?
I tell patients that it depends on their baseline risk factors and that some have reported rates as high as 25-28%. I discuss that if they have had prior anthracycline therapy, borderline baseline LVEF (50-54%), age > 65, and other cardiac risk factors like hypertension, that they could fall into th...
How do you manage T1-2 SCC of the lip postoperatively?
In my practice, the decision to re-resect vs RT in patients with close margins or high grade dysplasia depends on the ability to identify and reliably resect close or dysplastic margins without risk of oral incompetence.