Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you consider the duration of lung/lobar atelectasis in your decision making while offering airway stents for malignant central airway obstruction?
Yes, always. We review old imaging to determine when there is a post obstructive pneumonia or collapsed lobe/lung secondary to endobronchial obstruction (extrinsic or intrinsic). The old teaching was that, if a lobe is down for more than two months, it is unlikely to be salvaged, even after the endo...
Would you consider SBRT for a patient with a solitary HCC lesion, with SLE/lupus previously on immunosuppression?
This one is a little bit tough, because there are other treatments for a solitary HCC lesion (surgery, TACE, RFA...), it may be better to use those options and avoid the risk of potentially enhanced toxicity. However, I suspect the risk is not very large as the risk from SBRT to the liver is so smal...
Do you cover the sacral foramen when treating pelvic lymph nodes for prostate cancer?
I don’t cover the sacral foramen when treating the presacral nodal region for prostate or gynecological cancer - this reduces the dose to the sacrum and thus risk of insufficiency fracture. However, I do try to cover the foramen for locally advanced rectal cancer, especially with posterior mesorect...
What is your recommended management for a pT1N0 perianal moderately differentiated SCC s/p wide local excision with close 1 mm deep margin?
It’s important to examine the patient before proceeding. Anal and peri-anal cancer can be multi-centric. I have had cases with pathology reports like this who had other areas of clearly invasive disease remaining. Assuming staging studies are negative and the physical examination reveals only a hea...
How does the performance of a LYMPHA procedure affect the timing and planning of post-mastectomy radiation?
This is increasingly being seen for patients undergoing ALND with LYMPHA or LVB procedures. They often have their arm wrapped for several weeks post-op. I will try to simulate 4-6 weeks postop; prior to sim, my nurse will reach out and if the arm is still wrapped or limited ability to lift the arm, ...
Do you ever consider hypo-fractionated palliative radiation postoperatively for bone metastases?
Yes, we use it routinely. We consider it one of the wise choices.
For a stable AVM after SRS, would you consider repeat SRS?
Yes. 3 years.
Would you deliver post-operative axillary radiation for breast cancer patients who have contralateral axillary disease s/p ALND?
For recurrent disease involving contra lateral axilla, I have treated undissected axilla and supraclavicular region only (not contralateral breast or chest wall).
How can oncologists be more collaborative with palliative care physicians?
First and foremost, for oncologists to be collaborative with palliative care physicians, a trusting relationship is a must (good communication amongst teams is key to optimal patient care). This is akin to PCP-Oncologist (or even PCP-any other specialist relationship). Before advances in science and...
When would you offer radiation for poorly differentiated thyroid cancer?
PD thyroid cancers are rare, of follicular origin, often iodine unresponsive, and can be addressed with surgery and postop RT. More advanced disease presentation is a much larger issue and DM rates are as high as 60% with poor response to systemic therapy to date. Unlike anaplastic thyroid cancers t...