Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would a patient receiving intravitreal avastin have a contraindication to prostate radiation?
There may be some systemic effects but not enough for us to hold adjuvant RT.
In a patient with solitary metastasis skin/subcutaneous wrist, resected with graft, from a primary breast angiosarcoma, what would be your preferred fields and dose?
Agree, odd presentation. Hopefully, the patient was fully staged with PET and MRI brain after this was diagnosed to confirm solitary metastasis. If so, agree with chemo first; angiosarcoma in general, has formidable DM risk (though hard to know how much that applies to this presentation) so makes se...
In light of the recent MSKCC Phase 2 data indicating reduced skeletal events with treatment, how will you approach management of patients with asymptomatic bone mets?
It sounds promising, but there is not enough information about the cohort for me to make an informed assessment. One problem I have is that bone metastases from different primary malignancies really shouldn't be grouped together. It's a good starting point for more investigation, and I look forward ...
Would you offer palliative re-irradiation to the sacrum for a patient with a prior history of RT for rectal cancer?
Local recurrence of rectal cancer is still a quite common situation we see in the clinic. Presacral space lesion with sacral involvement is one of the most common scenarios. As a tertiary center, we have quite a few cases with locally recurrent rectal cancer. All these patients are evaluated by a mu...
Is there any data for prophylactic use of lymphedema sleeves during breast radiation?
The current data doesn’t suggest any benefit of prophylactic treatment but does show screening, and early intervention for any sign of subclinical lymphedema helps reduce the clinical lymphedema.
Do you utilize a constraint for skin/dermatitis in setting of thoracic chemoradiation?
No. This acute toxicity is almost universally reversible in short course and should have essentially no bearing on the decision making when treating a potentially lethal lung cancer; also, I know of no data quantifying skin tolerance doses.
For a patient with localized high risk prostate cancer with high risk Decipher score receiving ADT and abiraterone, is there any value of continuing ADT and abiraterone beyond two years?
Since the trial (STAMPEDE) stopped abi at 2 years, that is the longest duration that I use.In the mHSPC setting, we are seeing many patients stay on their first-line treatment for many years (often longer than 2 years). This has made me more cognizant of the long-term effects of abi/prednisone (acce...
On a field-in-field breast tangent plan do you have a minimum MU you accept for a subfield?
I usually avoid sub field with MU, less than 4-5 as adds little to plan quality and increases treatment time.
What would your approach be for a patient with early stage gastric cancer who declines a gastrectomy?
I would first clarify if less invasive endoscopic or operative strategies such as endoscopic resection (EMR vs ESD) or local resection/partial gastrectomy are appropriate and feasible based on the patient and disease related factors. If not, I’d recommend definitive chemoradiation, 50-50.4 Gy in 25-...
In a patient with otherwise low-risk prostate cancer, does presence of a small component of Grade Group 3 disease up-stage to unfavorable intermediate?
I agree with Dr. @Dr. First Last's response and will just add a couple of additional thoughts. There are many things that go into making a decision about whether treatment is necessary, and what type of treatment is performed. In this case, it's important to consider patient factors (i.e. age, co-mo...