Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are you considering SBRT in your prostate cancer patients who had a RP and now have a rising PSA and oligometastatic bone disease?
Yes, we offer SBRT for oligometastatic disease, with a frank discussion of current understanding of the potential benefits and risks. We await results of phase III trials, but smaller trials have been encouraging for a progression-free survival benefit (SABR-COMET, STOMP, ORIOLE).
How would you approach treatment of residual melanoma in situ of the perianal skin?
It sounds like this is a case of mucosal melanoma of the anal canal, with extension on to the perianal skin? Alternatively, this could be a case of true cutaneous melanoma on perianal skin. Further investigations might be helpful to clarify.In either case, this is an unusual situation in this anatom...
Would you give preop chemoradiation to a rectal cancer just above the peritoneal reflection with pelvic nodes seen on imaging?
Yes.
Would you offer postop chemoRT to a patient with pT3N2bM0 rectal cancer and ulcerative colitis s/p prococolectomy with j-pouch creation?
Great question. My answer is probably not but rarely maybe. Given that complete hedge, I will expand on what would influence my decision; the details are everything here. The first thing I would be doing is scrutinizing the pre-operative evaluation to understand how we ended up in this position in t...
How would you approach a patient who is s/p mastectomy with only DCIS in the breast and a large positive sentinel node?
If the patient had SLN only (no ALND), I would offer adjuvant radiation extrapolating from AMAROS. While only DCIS in the mastectomy specimen, nodal involvement suggests foci on invasion. Implant reconstruction may increase the complication profile but would not change my recommendation. Age < 50 wo...
When do you offer adjuvant radiation in addition to chemotherapy for patients with high risk localized gastric adenocarcinoma who did not receive pre-operative therapy?
Would recommend starting concurrent chemo-radiation 4-6 weeks postoperatively, when the patient has recovered from their surgical procedure.The US GI Intergroup trial 0116 demonstrated improvement in both RFS and OS for gastric cancer patients at high risk after surgery (T2-4N0, T1-4N+), who were ra...
Which genomic test do you use when considering active surveillance in prostate cancer?
As a prologue, molecular expression features, often grouped into "panels" with mathematical models for outcome estimation, can be useful to help patients and clinicians determine whether historical (often still standard) clinicopathological features don't under- or over-estimate risk of clinical sig...
Would you consider salvage SRS in a young patient with locally recurrent ATRT?
Radiotherapy plays an important role in the curative management of ATRT.[Chi et al, JCO 2009; Reddy et al JCO 2020].When relapse occurs, even if it is local, the overall prognosis is often poor. However, I am assuming that this was previously treated, and I would consider re-irradiation with SRS as ...
How do you manage a hemorrhage from a cavernous malformation following SRS?
As the evidence for benefit or irradiating AOVMs is circumstantial at best, I am referred quite a few. Bleeding after treatment would be managed on a case-by-case basis but would often be expectant and would not be influenced by the prior SRS. I would personally not re-treat an AOVM — especially the...
Would you recommend consolidative RT for an HIV-positive patient with Stage I bulky DLBCL of the mediastinum s/p R-EPOCH?
The simple answer is that for most bulky limited-stage DLBCLs, I would favor consolidation ISRT (Preferred per UpToDate and +/- per NCCN). Some support for consolidation RT for bulky DLBCL after modern regimens incorporating rituximab comes from the following: A comparison of patients not receiving ...