Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a p16 positive small cell carcinoma of the tonsil?
Assuming it is indeed small cell (undifferentiated, neuroendocrine pathological features), extrapulmonary small cell cancer rarely metastasizes to the brain as venous drainage to the brain must first go through the lungs and produce subclinical lung metas. Therefore, there is a very low rate of brai...
With the RAPIDO trial demonstrating efficacy of short course XRT as part of TNT for locally advanced rectal cancer, is there a role for short course XRT to be integrated into watch and wait programs?
Great question, and one our group has discussed extensively. Our group currently uses short course radiation nearly exclusively in the treatment of locally advanced rectal cancer. One notable exception (at least so far) is if the patient desires NOM. Our rationale is that there aren’t as many data f...
How do you manage acute tenesmus related to SpaceOAR?
Fortunately, this does not happen very often. First, make sure there is no mucosal injury by inquiring about significant hematochezia. If there is, then delay sim, consult colorectal surgeon or GI just to be safe, but usually, this will resolve with conservative management. If there is no hematoche...
Would you give post-mastectomy radiation for a T2N1 triple negative BRCA 2+ patient who had a complete response from neoadjuvant chemo?
When B51 was opened, we offered that. Otherwise, outside clinical trial triple negative with node positive disease recommend PMRT irrespective of response to NACT.
How would you approach treatment of a patient with asymptomatic, oligometastatic basal cell carcinoma?
This is an unusual situation. I would want to clarify whether this is regional versus distant metastasis, and what is meant by "oligometastatic". I would also want the diagnosis of metastatic basal cell carcinoma confirmed histopathologically (and possibly even molecularly) for both a putative prima...
What is an appropriate steroid regimen for a patient treated with RT for spinal cord compression?
I don't believe there is a specific answer to the question; this represents the art of medicine. The highest dose that I recommend is 16 mg of dexamethasone a day. This would be for the patient who has severe neurologic symptoms (weakness, numbness, and/or bladder or bowel symptoms). However, often ...
In a healthy patient >65 years of age with glioblastoma multiforme, what is the recommendation for temozolomide when given concurrently with adjuvant radiation therapy?
Glioblastoma (GBM) is primarily a disease of older adults. The median age of diagnosis is around 60. Many of these patients present with a host of co-morbidities that impact their performance status (PS), overlapping with GBM-related complications. There are multiple scenarios to consider when evalu...
Is it safe to deliver SBRT with concurrent immunotherapy to head and neck sites of progressive metastatic disease?
Yes, have done this many times. Constraints are hard to come by. If it is reirradiation, RTOG 3507 provides guidance, if it is never radiated you have even more leeway.
For early stage TNBC without nodal disease, is a prone breast setup contraindicated due to concerns of suboptimal chest wall coverage?
There is no data to suggest that we need to cover chest wall for early stage TNBC after BCS.
How would you approach patients who have undergone nipple sparing mastectomies with close or positive margins at the nipple areola complex?
We have treated a few patients with adjuvant RT with the same principal of positive margin and literature suggests that nipple areolar complex tolerates RT well with no excessive risk of complex failure.