Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?
This is a challenge for our center, and many other centers as well. The ideal approach would be to have adult primary care physicians associated with our center who have dedicated clinic time to care for cancer survivors, direct access to our expertise and medical records. While we haven't been succ...
What target volume and dose would you boost for inflammatory breast cancer with prepectoral saline implant?
There is no defined boost volume and if has a poor response to chemo, would take tangential chest wall field to mid 50s dose.
For which head and neck cancer patients do you or your dental colleagues recommend fluoride?
DDS or I will prescribe Rx-strength fluoride toothpaste (1.1%, which is ~ 5X as many parts per million relative to commercial toothpaste) to all patients in whom we anticipate some degree of radiation-induced xerostomia (RIX). My general approach for most H&N patients in whom we anticipate RIX: Pr...
How would you sequence 177LU-PSMA-617 with current therapies for men with mCRPC?
I would like to congratulate the VISION study investigators and Dr. @Dr. First Last for the outstanding presentation and good news. The study was designed to use a hybrid control (best "standard of care"-SOC) and as such, it met its endpoints (OS, rPFS, etc). Secondary endpoints also significantly f...
Do you use the highest or most recent PSA for risk stratification for newly diagnosed prostate cancer?
This happens on occasion and can be a dilemma. First, I would repeat the PSA and see if it is <20 or >20, and take that into account. I would also take into account the genomic score. This may help further clarify the patient's risk category. If the patient had a reason for the first elevated PSA li...
Can Trental + Vit E for treatment of fibrosis be used in patients taking anticoagulants?
Vitamin E can definitely increase bleeding and should not be prescribed by a radiation oncologist for a patient on anti-coagulation. However, bleeding is not a commonly reported side effect of Trental. (Though bleeding does make the extensive list of possible complications.) It inhibits phosphodiest...
In a patient who is planned for WBRT for multiple brain metastases but also needs breast palliation, do you favor breast radiation over palliative mastectomy?
Why not concurrent? 30/10 to both. Can add a few more to breast, sometimes I go to 39 Gy/13 fx. If not concurrent (why, though?), then just depends on which seems more bothersome. The breast has probably been there for quite a while, so perhaps address brain and then re-assess.
What is your preferred IGRT strategy when treating breast cancer using IMRT?
For regional nodal patients: we use daily kv CBCT to bone/chest wall on Halycon for the majority of our patients. Our C-arm linacs use daily kv-kv to bone/chest wall for alignment (faster). All patients with VMAT/multibeam IMRT are treated in custom immobilization on a breast board instead of breast...
How would you proceed for a patient with metastatic gastric-type adenocarcinoma, with vaginal and inguinofemoral disease only, who experiences complete response to her vaginal tumor but residual inguinal disease?
There is no ideal data to guide this. I would recommend surgical nodal excision of the residual inguinal disease, followed by pelvic and inguinal radiation (with or without platinum if the patient can tolerate further). Another approach would be with cisplatin-based chemoradiotherapy with treatment ...
How would you design your post-op radiation field for pT4a laryngeal SCC with subglottic extension s/p TL, who has a TE fistula?
PEG and irradiate. The TE fistula won’t be fatal, the cancer will be.