Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer PCI to a patient with LS-SCLC, who presented initially with paraneoplastic syndrome (encephalomyelitis), but had no neurocognitive sequelae after chemoradiation?
I am not a big fan of PCI. I think the term itself is a misnomer. PCI trials in LS-SCLC were conducted in an era when MRI brains were not performed.Let's look at the "outdated" data that all of us, including NCCN, quote. A meta-analysis conducted by Auperin and colleagues demonstrated a 5.4% 3-year ...
What dose-fractionation scheme do you recommend for the treatment of leukemia cutis?
Leukemia cutis (LC) is a form of cutaneous extra-medullary leukemia that confers a relatively poor prognosis, with a median survival of <12 months. Since most of these patients have additional sites of involvement (spleen, liver, CNS), the mainstay of treatment of EMD leukemias is still considered t...
What is your hemoglobin transfusion threshold for asymptomatic pediatric solid tumor patients during radiation?
We aim for a Hb of 10g/dL whenever possible. This is not based on any data from pediatrics, but from data in adult patients (Prognostic value of hemoglobin concentrations and blood transfusions in a retrospective study of 386 patients).
In a patient with newly diagnosed anal squamous cell carcinoma, who has an extensive history of active autoimmune disease including Crohn's, Lupus, and arthropathies on multiple therapies, would you forgo radiation therapy and proceed to APR upfront?
I've treated patients like this with standard chemoradiation, and while the GI toxicities are certainly increased, we have gotten them through curative treatment with aggressive symptom management. I would carefully counsel patients on APR vs increased risks of chemoradiation in the autoimmune conte...
Can liquid biopsy be substituted for tissue biopsy in a lung mass that is radiologically suspicious for primary lung cancer when CT-guided biopsy cannot be done?
Generally, the utility of liquid biopsy remains in the ability to provide genomic information from cfDNA. A liquid biopsy will not provide a definitive tissue diagnosis and does not provide information about histology. When a histologic diagnosis is made with biopsy or FNA but the sample is insuffic...
Do you stop treatment for a prostate cancer patient diagnosed with acute radiation proctitis with significant pain?
I would first check the treatment fields and treatment setup to ensure that there isn't excessive dose going to the anorectum. As with all toxicities in radiation oncology, one must exclude other possible reasons for the anorectal pain such as hemorrhoids, infection, or inflammatory bowel disease. I...
How do you counsel patients who are candidates for a clinical trial regarding their options?
I typically discuss the option with patients as early as possible in their diagnosis, and explain that at some point during their treatment they may become a candidate for a clinical trial. I discuss resources to look into clinical trials and what they mean for patients. We discuss patient website r...
How do you approach multiply recurrent early-stage oral tongue SCC despite multiple resections?
Surgery and postop RT.
Would you consider XRT for relapsed seminoma in the retroperitoneum, pelvis, and mediastinum with good response after chemo, but with poor kidney function?
If the patient has responded to chemo and has residual mass, most likely it is benign with fibrosis and PET scan in this setting can help as has very high negative predictive value.
What is your practice for the use of bolus in patients with breast cancer who had mastectomy and expander placement?
We still treat with bolus on these patients (0.3cm QOD for first 10 days), however, a retrospective review was published in the Red Journal recently that is interesting.In this review, >1500 patients were treated with bolus, 318 had no bolus (basically, half of the reconstructed patients). There was...