Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for radiotherapy to the primary in high volume metastatic prostate cancer with well controlled disease on ADT?
Yes, for some patients. Recent evidence supports an emerging role for prostate RT in the de novo high volume mHSPC population with the goal of preventing serious and symptomatic events from local disease progression. A 2023 update of STAMPEDE arm H demonstrated a significant reduction in the 5-year ...
For a patient with adenosarcoma of the ovary with high grade sarcomatous overgrowth removed intact with appropriate oncologic surgery, is there any role for radiation?
I don't see a role for adjuvant RT in this case. Should she develop a pelvic-only recurrence, then RT would be an appropriate modality.
Do you ever utilize short-course radiation when lateral pelvic (extra-mesorectal) lymph nodes are involved?
My general preference is to use long course chemoradiation for patients with involved extramesorectal/lateral lymph nodes as it is a relatively strong risk factor for pelvic recurrence and such lymph nodes are not routinely surgically resected. While the pre-TNT era randomized trials comparing short...
How would you treat the primary site of an adenoid cystic carcinoma of the floor of mouth s/p resection with positive margins with oligometastatic disease?
Postop RT and SBRT or resection of what would likely be a lung met.
How would you approach a patient with clinical T3N1 anorectal malignant melanoma referred by a surgeon for neoadjuvant therapy?
Anorectal malignant melanoma is quite rare and only <1 percent of all anorectal cancer are mucosal melanoma (Cagir et al., PMID 10496563) Patients with newly diagnosed anorectal malignant melanoma should undergo HIV screening since HIV infection is considered to be one of the main risk factors (Cagi...
How do you manage radiation plexopathy?
This is a frustrating problem. I agree that there are no proven treatments for radiation plexopathy. However, chronic radiation injuries appear due at least in part to an ongoing inflammatory process. Interrupting this process with pentoxifylline and Vitamin E has been successful in reversing fibros...
In which scenarios, would you consider a planned neck dissection following definitive radiation therapy?
Persistent induration despite a negative PET, particularly if HPV negative, or if unable to go to full dose.
What dose and fractionation regimen would you use for a patient with DCIS with multiple close margins unable to undergo re-excision, who has a history of photosensitivity (polymorphous light eruption)?
Generally, photosensitivity doesn't lead to higher photon reactions. That being said, I would get the pre-RT mammogram done to rule out residual calcification before RT and favor whole breast to 40 in 15 with higher 16 Gy equivalent boost dose.
What intracavitary brachytherapy dose (and fractionation) would you recommend for stage I vaginal cancer post-resection with positive (R1) margins?
Presuming nodes have been addressed or don’t need to be addressed. For brachy alone cases, I have done 6 Gy x 6 to GTV area with MRI planning with the first 4 or 5 fractions treating longer length especially if has VIN for microscopic dose and disease.
Would you offer radiation therapy for extramedullary testicular masses in the setting of multiple myeloma?
If a patient had a symptomatic plasmacytoma involving the testicle (which I don't think I have ever encountered), not responding to systemic therapy, palliative radiation therapy would be a reasonable modality. I would probably start with a very low dose and assess the response to therapy (2 Gy X 2)...