Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your go to steroid regimen for post SRS headache?
Start with Dex 2mg. If that works, then that's it. If it continues, can take a second dose later in the day. It is usually transient, so I don't prefer to give high/long doses and just manage as it comes. Typically, in a day or two, it appears to resolve in my experience.
How would you treat margin positive, node positive (pN+) prostate cancer with detectable post-op PSA but negative PSMA-PET after radical perineal prostatectomy?
Ideally, enroll the patient in a clinical trial like NRG GU-008. Off trial, would treat with salvage RT to the prostate bed and lymph nodes with long term (2 years) ADT. You can consider an MRI to see if there's a nodule in the prostate bed to boost, which may be more likely given a positive margin....
How do you manage an infection that occurs in the treatment field while under treatment?
I believe it is rare to develop an infection within the treated volume. When it does happen, treating with antibiotics and continuing treatment is probably best. If it is an abscess, then sometimes drainage with possible re-planning is necessary. I generally do not stop treatment unless the patient ...
How would you manage an endometrial adeno abdominal wall recurrence at the port site from prior laparoscopic surgery?
I agree with R0 resection and would echo postoperative RT if it is the only site of disease. Oncologic abdominal wall resections are not routine for most surgeons and don't have standardized approaches. Make sure that your surgeon and pathologist understand that you want it evaluated similarly to a ...
How would you approach a patient considered to be unfit for cystectomy with recurrent NMIBC refractory to BCG, failed pembrolizumab and unable to do more intravesical Rx?
This seems to be a very difficult scenario, what are the reasons for not being able to pursue intravesical therapies? Nadofaragene firadenovec just got FDA approval, while there have been data with intravesical gemcitabine/docetaxel. We are waiting for the FDA decision on N-803/BCG combo (QUILT-3.03...
How do you counsel a patient with early stage breast cancer, planned for breast conserving surgery, who wants implants at the time of surgery or soon thereafter?
I usually say something like: “Let’s cure this cancer first and then address the implant issue down the road. I would not want to do something now related to cosmetic concerns that might complicate our ability to optimally treat your cancer. While the cancer appears to be favorable, etc., and implan...
Would you offer consolidative RT for NEC of the esophagus with good response to systemic therapy?
Yes
How would you manage a premenopausal patient with HER-2 positive DCIS in the setting of a prior HER-2 positive contralateral breast cancer?
NSABP B-43 looked at the combination of post-op RT + trastuzumab vs RT alone in HER2+ DCIS and while there was a numerically lower number of IBTR events in the trastuzumab arm, this did not reach statistical significance. At this time, we do not manage our HER2+ DCIS patients differently than HER2-....
Do you hold anticoagulation prior to prostate brachytherapy?
Yes, but always per the patient's cardiologist's recommendation. Also not even after the designated time for withholding meds may still be anti coaged so we get pt/ptt morning of the procedure.
How would you approach a patient with low grade follicular lymphoma (stage IE) of the breast who presents with local recurrence 1 year s/p lumpectomy?
I would re-stage the patient with imaging. If the disease remains localized, then I would treat with definitive RT (24-30 Gy in 2 Gy fractions using ISRT principles). It would be interesting to look back at the pathology from the original lumpectomy. Unless margins were widely negative, I would prob...