Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would diagnosis of a low grade, non-invasive papillary bladder cancer alter your recommendations for salvage prostate radiotherapy after rising PSA?
I would treat with salvage RT as that’s definitive treatment for recurrent prostate cancer and treat non invasive bladder cancer with TURBT and cystoscopic surveillance.
Would you offer neoadjuvant chemotherapy for a large, but recurrent grade 1-2 myxoid chondrosarcoma of knee which is no longer amenable to limb salvage?
While not directly relevant for this patient, it is also important to keep in mind that RT is quite effective in decreasing LF in chondrosarcoma, particularly in anatomically challenging locations like joints/pelvis/spine where wide margins often cannot be achieved. The benefit of RT (HR 0.23 for LF...
Is there an age beyond which you will not perform salvage prostate brachytherapy?
No, I don't have an age limit (upper or lower). However, I would always have a discussion with the patient so I understand his concerns and wishes, and I will always make sure he understands his treatment options, pros and cons of any type of treatment. I will also review his medical co-morbidities ...
How do you approach at-risk draining nodes and the bronchial stump in PORT volumes for margin-positive, pN0 NSCLC?
For a positive-margin, pN0 NSCLC, I would only treat the positive margin region. In a pN0 patient, there would be no benefit to treating the mediastinum prophylactically and there is certainly no evidence for this. One could perhaps make an argument for prophylactically treating regional LNs if the ...
How would you mange a completely excised true anal margin squamous cell carcinoma, with anal canal uninvolved, with positive inguinal nodes that were not managed surgically?
Chemo RT to anal margin, anal canal, inguinal and pelvic nodes to 45 Gy/25 fx. Boost positive inguinal nodes to 55.8-59.4 at 1.8 Gy/fx. PET at 3 months. Resect whatever is left (hopefully nothing).
How would you treat a Stage I DLBCL invading the mandible?
If a patient had an early-stage DLBCL of the oropharynx (e.g., tonsil) with minimal mandibular invasion, who was otherwise low risk by the IPI, then I think 3 cycles of R-CHOP followed by consolidation RT (30 Gy) would be quite reasonable. If the disease was bulky or if there was significant bone in...
How soon after EBRT would you consider salvage brachytherapy for biopsy confirmed local recurrence of prostate cancer?
In general, salvage re-irradiation should only be performed in the setting of biopsy-proven recurrent disease. The definition of a biopsy-proven disease post an initial course of prostate radiation would be histologic evidence of a recurrence with gradable disease that could be classified with a Gle...
Do you typically incorporate radiotherapy into the management of extraskeletal myxoid chondrosarcoma?
Yes. RT appears to be quite effective in improving LC for chondrosarcomas, including extraskeletal myxoids. This is likely to be particularly relevant where wide margins cannot be obtained (e.g., spine, pelvis, joints).The benefit of RT (HR 0.27 for LF) was nicely shown in a recent large, well-condu...
What is the role of preoperative radiation in patients with bone metastases needing surgical stabilization (ie. ORIF), but without tumor resection?
It depends on the patient’s primary diagnosis, extent of disease (multiple metastases vs oligometastastes), and life expectancy. These factors help us formulate a treatment plan on whether we are going to deliver higher ablative doses for patients with longer life expectancy where the ultimate aim i...
How do you approach a tumor bed recurrence after previous neoadjuvant chemo and cystectomy for bladder cancer?
I would opt for concurrent chemoRT in most instances. Here is my explanation as to why: First, I think it's important to establish that recurrence of bladder cancer after radical cystectomy (RC) usually portends a very poor prognosis; these patients have a median survival of 5.6 months after diagnos...