Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend salvage RT in a patient who previously had prostatectomy for high risk prostate cancer who is no longer tolerating his intermittent hormonal therapy?
Why was hormone therapy started. BCr or adjuvant ? if adjuvant doesn’t need any treatment and just psa surveillance
Do you offer ADT in patients with intermediate risk prostate cancer who receive hypofractionated EBRT?
There is no good evidence that with different radiotherapy dose/fx or other RT modalities that the relative benefit of ADT is any different. This applies also to SBRT, brachy, and combo-brachy. The basic evidence and logic is as follows:1. ADT improves MFS and OS in multiple RCTs using lower dose co...
If tumor is stradling the peritoneal reflection how do you decide whether to treat with neoadjuvant chemo/RT vs just surgery?
There are many definitions used to delineate the sigmoid colon from the rectum. The peritoneal reflection is only one of these, and it may not be the most clinically useful. The location of the peritoneal reflection varies with age and gender, and it typically extends more inferiorly on the anterior...
How do you account for tumor growth from pre-operative to intra-operative ultrasound for uveal melanoma?
PDT: photodynamic therapy for amelanotic melanoma. Intravitreal chemotherapy is under investigation and also intra-arterial chemotherapy (not yet standard of care)
Would you require pre-RT dental evaluation and clearance for a patient who is being treated with ISRT to Waldeyer's ring/BOT area to 30 - 36Gy?
Yes. In the pre IMRT days, we certainly experienced some dryness and dental issues at dose of 30Gy, albeit much less severe than with typical carcinoma doses. With IMRT and salivary gland sparing the problem is clearly less, but it's hard to argue against a good dental evaluation pre RT. Talk with t...
What is the role of consolidative RT to initially bulky sites (>8cm) in a patient with stage III triple hit lymphoma who has tolerated only 4 cycles of DA-EPOCH-R?
I am going to expand the question to consider the role of RT in the curative rx of stage III/IV DLBCL triple hit or not. Conventional wisdom, e.g. NCCN guidelines suggest no role but I respectfully disagree. We reviewed the data in 2014 (Oncology 1074-1082, Dec 2014) and also recommend Dabaja et al ...
What dose-fractionation would you use for a recurrent basal cell carcinoma of the right ear concha close to the tympanic membrane status-post multiple Mohs surgeries with close/positive margins?
I would get a second surgical opinion. Any dose/fractionation scheme given with curative intent will cause terrible wet desquamation and likely complete hearing loss. This patient needs a curative-intent surgery by a base of skull surgeon who will get adequate margins around this and the patient wil...
Should indications for postmastectomy radiation be different after a Goldilocks mastectomy?
Not a lot of data though there is this abstract which included a small number of patients receiving RT (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959682/) In general, I would not use different indications for PMRT with patients undergoing Goldilocks mastectomy. For T3N0 cases, I tend to look mo...
Is there a role for adjuvant radiotherapy for a symptomatic vertebral body hemangioma following debulking surgery?
Yes. 45 Gy in 25 fractions
Should you offer radiation therapy to a low risk prostate cancer patient on active surveillance so that he may receive testosterone supplementation?
Great question. In my experience I can recall at least 3 or 4 patients who were subsequently dx'ed with PC after starting a testosterone supplementation.So, serious treatment and future considerations must be the matter of both doctor and patient in terms of the potential for tumor progression while...