Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient with profound dyspareunia after pelvic radiation for anal cancer?
Thanks for bringing up this important topic that remains understudied, with historically widely underestimated incidences of post-radiotherapy dyspareunia. There is currently no standardized method or schedule for assessing post-treatment sexual dysfunction including vaginal stenosis and fibrosis (a...
What is your dose and target for a H3K27M mutant diffuse midline glioma in a young adult following maximal safe resection?
It is important to recognize, that while most H3K27M mutant midline gliomas in young adults are high grade (GBM equivalent), some are actually histologic, more benign tumors (although they tend to occur in other locations). Therefore, a correct histological diagnosis is still necessary. My preferenc...
What is your approach in deciding on definitive therapy for locally advanced, HPV-negative head and neck cancer unsuitable for standard cisplatin based chemo?
The real answer is it depends on the medical oncologist as (s)he typically administers the therapy.It also depends on why cisplatin is contraindicated. Is it an otherwise healthy patient who has renal or hearing issues, or is it an elderly patient with a marginal PS for whom cytotoxics, in general, ...
Would you treat a seminal vesicle only recurrence with XRT in a patient who recieved prior XRT to the prostate but not the SV?
Dr. Anthony D’Amico noted that: "Assuming the rest of the findings are PET (-) and the SV recurrence is bx proven you can consider: You could consider HDR or MRI Linac SBRT (7 Gy x 5)".
How do you treat a large, resected ex pleomorphic adenoma with unknown margin status due to tumor fragmentation?
Treat the tumor bed to 60-66Gy, no systemic therapy needed.
What is the optimal work-up for patient with repeatedly negative biopsies of a mid-rectal lesion with signs of malignant etiology?
It is not that rare to get negative biopsies initially in rectal cancer, as superficial tissue only is biopsied. I generally recommend that at repeat biopsies, attempts are made to biopsy deeply to get diagnostic tissue. One approach is to have the surgeons biopsy with a rigid endoscope- they can us...
For a breast cancer patient who previously underwent lumpectomy/SLN biopsy and PBI with brachytherapy, what volume would you treat for an isolated axillary recurrence s/p ALND and chemo?
How long has it been since initial brachytherapy? If > 2 years from initial treatment, I typically will treat breast/chest wall and regional nodes. If < 2 years, I would consider regional nodes only; however, would also look at the original plan as some UOQ PBI cases may give a dose to the axilla.
What is the role of SRS in the treatment of malignant gliomas?
This is a good question that has been formally studied. RTOG 93-05 was a negative phase III randomized trial of chemo-RT with or without an up-front SRS boost for glioblastoma. Results were published in the Souhami et al., PMID 15465203. Tumors had to be 4 cm or smaller to be eligible. Tumors were a...
How do you handle risk stratifying and radiation treatment in a patient with concurrent MRI diagnosed asymptomatic prostatitis and prostate cancer diagnosis?
My concern, in this case, is that whatever has been uncovered by the MRI might be artificially elevating the PSA, which might result in erroneously classifying the patient into a higher risk category, leading to more treatment than is necessary. Personally, I have never seen a clinically significant...
Does diffuse high grade PIN in a low risk prostate cancer patient affect your recommendation for surveillance?
No. If the patient otherwise has low-risk prostate cancer, surveillance is appropriate. The diffuse high-grade PIN might raise the chance of occult cancer (that could be higher grade), but not more so than a widespread Gleason 3+3 disease, which is not, by itself, a contraindication to active survei...