Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of MRI in target delineation of radiation therapy for non-NPC H&N cancers?
I don't think MRI is necessary for most OPCs. I do use MRI in some cases, such as 1) patients being considered for surgery first (to determine if endophytic tumor is better suited for RT), 2) whenever I have clinical concern for perineural spread, and 3) to further assess deep invasion or involvemen...
Is there an indication for bolus in whole breast RT for early-stage invasive ductal carcinoma with micropapillary features?
I have not and would not suggest changing RT management based on histology alone unless dermal lymphatics invasion was seen on pathology.
How would you approach adjuvant therapy for a patient with pT2N2 lung adenocarcinoma who underwent an R1 resection and is not amenable to further surgical intervention?
I don't know that I have a trial (much less a randomized one) to prove this, however in this situation, assuming the patient has adequate functional status and has recovered sufficiently from surgery, I would treat the surgery as an extended biopsy. I.e., I would probably (with my radiation colleagu...
Are there best practices or data regarding the use of open notes among oncology patients?
The 21st Century Cures Act regulation (effective April 2021) required that clinical notes such as consult and office notes be shared with patients, e.g. “open notes.” In general, surveys of patients with cancer and their clinicians suggest that open notes are viewed favorably (Salmi et al., PMID 330...
How would you treat prostate cancer that recurs after radical prostatectomy with invasion into bladder, rectum and musculature?
In a case with extensive disease like this, I would first restage ideally with a molecular study like PSMA to ensure no evidence of metastatic disease. In the absence of metastatic disease, I would recommend starting with ADT (+/- abiraterone or other novel anti-androgen) to downsize disease away fr...
For a patient with breast cancer s/p lumpectomy found to have a heterozygous RAD50 mutation, is adjuvant radiation appropriate therapy or would you recommend completion mastectomy?
Rad50 is part of the homologous recombination repair pathway. If cancer cells have homozygous loss of Rad50, they will be exquisitely sensitive to radiation therapy, which causes lethal DNA double-strand breaks via oxygen free radicals. Theoretically, adjuvant radiation is an excellent treatment bas...
Is there a role for radiation therapy for heterotopic ossification prophylaxis of the ankle?
Yes.
Do you offer adjuvant therapy for rectal intramucosal carcinoma within a large rectal adenoma?
Not if the margins are negative and it’s not into the muscularis.
If vertebral body pain is not controlled with a single 8 Gy fraction, what non-SBRT dose scheme would you consider for re-treatment?
My recommendation regarding a second course of radiation after a single fraction of 8 Gy depends on… a) Did the 8 Gy work at all? My usual practice has been to recommend repeat radiation therapy only if the first course helped. You could argue that maybe 8 Gy “just wasn’t enough” but many studies sh...
What are your skull constraints when administering cranial SRS/fSRS?
I have never used skull constraints when delivering intracranial SRS. While intuitive to think about any adjacent uninvolved tissue as an organ at risk and limit the dose to said structure, in relation to the skull bone itself the cost of "spray" dose to the skull is much less costly than the altern...