Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does diffuse high grade PIN in a low risk prostate cancer patient affect your recommendation for surveillance?
No. If the patient otherwise has low-risk prostate cancer, surveillance is appropriate. The diffuse high-grade PIN might raise the chance of occult cancer (that could be higher grade), but not more so than a widespread Gleason 3+3 disease, which is not, by itself, a contraindication to active survei...
What is your treatment approach to radiation-induced meningiomas?
There is an unambiguous relationship between ionizing radiation and meningioma, the most commonly reported radiation-associated neoplasm [1,2]. It is thus perhaps curious that radiation therapy (RT) is 1 of the only 2 definitive management options for meningioma in the current era. Systemic therapie...
Is there a role for post operative elective nodal irradiation in locally advanced sinonasal, clinically N0, intestinal type adenocarcinoma (ITAC)?
While I agree with Dr. @Dr. First Last's reply regarding post-operative ENI for high-risk sinonasal malignancies, I would like to offer a few points about treatment technique: Historically, treatment with conformal RT for localized malignancy at paranasal sinus (PNS) or nasal fossa would involve ort...
How would you manage newly diagnosed spinal cord compression presenting with paraplegia without tissue confirmation?
How do you approach the pharmacologic management of cancer-related fatigue?
After the above considerations mentioned in the question, management considerations regarding cancer-related fatigue depend on the stage of disease (advanced/metastatic disease vs not) and whether the patient is on active cancer therapy. For both groups, non-pharmacologic interventions have the high...
Based on the SENTINA trial, is it reasonable to allow for axillary assessment via SLNB alone (without axillary dissection) after neoadjuvant chemotherapy for an upfront clinically node-positive patient?
False-negative is reduced to 5% or low with dual tracer, taking more than two sentinel nodes out and making sure bx positive node is clipped, localized, and taken out.
How would you treat a skull based chordoma in a pediatric patient?
Do you recommend PMRT and if so, do you treat the regional nodes, in patients who are cT4N0 (non-inflammatory) treated with neoadjuvant chemotherapy who have a pCR at the time of mastectomy?
I would recommend PMRT and treat chest wall and regional node comprehensively. At present those who present with clinical stage III disease like above and have pCR we recommend PMRT. Some of them are suitable for B51 also (stage III and node positive upfront converted to node negative) and we do off...
What is your preferred palliative radiation regimen for patients with painful bone metastasis?
Because of the great work of the BM Working Group led by Hartsell et al, and the Dutch, for examples, there are ample category 1 data supporting the use of Single Fraction (800cGyx1) EBRT for "uncomplicated" bone lesions. That is, the use of 800cGy x1 unless there is: a soft tissue component, an imp...
Do you do urethrogram at time of prostate simulation?
We don't perform a urethrogam. We do MRI with a pelvic coil and fuse it with the CT scan which helps to identify the base, lateral edge and apex appropriately.