Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the utility of a biopsy in the setting of an elevated post-prostatectomy PSA and imaging noting a local prostate bed recurrence?
It would generally be reasonable to treat an imaging detected prostate bed mass without a confirmatory biopsy if one was going to treat the patient whether the biopsy was positive or negative. Some radiation oncologists are escalating doses to higher that standard levels in the postoperative setting...
Would you recommend PMRT in a patient with dermal invasion as the sole adverse feature after a skin sparing mastectomy for an early stage breast cancer?
Pathological dermis involvement in these early stage patients is function of location ( like retroareolar or superficial location) rather than aggressiveness of disease and thus outcome is more like early stage disease In absence of other adverse factor I would favor observation
Would you recommend observation in an elderly patient with an ER positive, early stage breast cancer who has a high risk Oncotype Dx score?
I would not favor observation in high oncotype Dx as is it is a risk factor for high local relapse (based on NSABP where it showed higher risk relapse even after lumpectomy and RT, although risk was higher in younger vs. older).Even in PRIME 2 high grade was associated with higher risk of relapse wi...
What types of sexual side effects do you discuss with men undergoing radiation therapy for rectal and/or anal cancer?
This is an excellent question as the literature is pretty clear sexual side effects of non-gynecologic or prostate cancer therapy are often omitted from discussion before therapy or in follow-up. Consequently, there is limited data on sexual dysfunction for rectal or anal cancer survivors. The studi...
What imaging surveillance do you do after SABR of oligo lung metastases?
Since these are metastatic patients I would recommend chest CT scans every 3-4 months for the first and second years. Abdomen and pelvis CT scans could also be done depending on the patient and their disease. I do not recommend PET-CT after SBRT for lung metastases or after SBRT for lung primaries. ...
How do you counsel patients in regards to the options and risks for salvage lobectomy/wedge after SBRT?
For early stage lung cancer, we discuss with our patients the surgical and nonsurgical options, and provide the rationale for our recommendation. A common question is whether the patient can have surgery if the SBRT doesn't work. I think SBRT patients need to know two things relating to this questio...
When do you consider neoadjuvant chemotherapy prior to definitive chemoradiation for cervical cancer?
Although we are occassionally referred patients for "consolidation" of loco-regional disease after favorable responses to chemotherapy for stage IVB disease, we very rarely give neoadjuvant chemotherapy for patients with stage I-IVA cancers with nodal disease confined to the pelvis and PA regions. E...
Do you ever recommend PORT or chemoRT rather than chemotherapy alone for NSCLC with adverse features other than positive margins or N2 disease?
Despite the numerous limitations of the PORT meta-analysis, and subsequent non-randomized studies of postoperative RT in NSCLC, one message seems clear (at least to me)- radiation therapy can cause harm. In patients with resected lung cancer (who often have many co-morbidities), prudence seems a wis...
How do you apply bolus and confirm daily air gaps/setup for vulvar cancer, especially for larger, fungating lesions?
For me, I am into "wet cotton gauze" wrapped in (new) plastic wrapping daily....for it is more conformal than even the old paraffin wax molds I used to use back in the day. Clearly, it is at best a 'guess-ti-mate' as to the thickness required for each case. But it does and has worked well in my expe...
With vaginal cuff brachytherapy, do you treat to active or treatment length?
There is no consensus what length to treat. The data for 2 to 5 cm appears to have similar outcomes. We treat 3 cm length so we have 7 dwell positions but as the rectovaginal septum thins out in the mid and lower vagina, the depth of prescription of 5 mm is usually in upper 2 cm or so only. Beyond t...