Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend that patients undergoing radiation treatment get a COVID vaccine booster?
Yes, we are recommending the third dose booster for our patients who are moderately or severely immunosuppressed. In addition to anyone getting chemoradiation, I would consider anyone treated with large field radiation to begin that category. As for timing, would start before treatment ideally. As f...
Will you consider adding an AR targeted agent to ADT for a patient thought to have isolated pelvic nodal recurrence of prostate CA if next generation imaging reveals additional non-regional disease not seen on conventional imaging?
There are no formal prospective trials addressing the question of timing (i.e. initiation of systemic therapy) based on metastasis identified on molecular only imaging. The best data available is based on the three trials in non-metastatic castration-resistant prostate cancer (PROSPER, ARAMIS, and S...
Does multiple myeloma become more radioresistant post transplant?
Anecdotally, I had a recent myeloma patient who developed progressive chest wall disease after ASCT and numerous prior rounds of therapy. I gave him 8 Gy in one fraction to two chest wall sites; one had a partial response before progressing months later, the second site progressed through RT with no...
What is your approach to the management of hot flashes in a patient who wants to use herbal medicine?
Hot flashes are so bothersome to some postmenopausal women, especially those with breast cancer in whom we discourage the use of estrogen or potentially estrogenic, that we now have evidence from randomized trials to help guide treatment. With regard to nonprescription therapies, data thus far suppo...
How would you manage early-stage low rectal cancer in a patient unable or unwilling to undergo surgery?
This patient may have multiple non-TME alternative options. Trans-anal excision with or without post-op CRT based upon pathological risk factors would be one option. Alternatively, CRT as part of a non-operative management/watch and wait strategy is also associated with favorable outcomes. Here are ...
How would you approach definitive treatment of intermediate-risk prostate cancer with baseline severe (AUA >25) urinary dysfunction and severe rheumatoid arthritis?
This case presented has a number of possible variables. First, does intermediate risk in this case, Gleason 7, 3+4, or 4+3 or some other set of variables making the case intermediate risk? That might change management in terms of use of ADT use, etc. However, the question's focus appears to ask for ...
How do you approach radiation volumes and dose for unknown primary presumed minor salivary gland carcinoma?
Ignore the presumption. After a PET scan and thorough surgical work up do not yield a primary, just treat the involved neck on its own merit. N1 = neck dissection only. N2 or greater = follow ND with PORT.
How would you manage a nodal recurrence of cutaneous SCC if the patient is unable to receive surgery for 6-8 weeks?
I’d first consider referring the patient to a center that could perform the operation, as it is standard of care for a patient with resectable cSCC with nodal metastases. At some centers, there may be a clinical trial of neoadjuvant immunotherapy that could be considered. If those options were not...
Would you consider radiation therapy for prostate cancer in a patient with osteogenesis imperfecta?
I would use a modality to reduce dose to bone as much as possible and would favor brachytherapy if feasible as this would give the least dose to bones.
How would you manage a patient with favorable intermediate prostate cancer patient who obtains a high Decipher test score at the end of their RT course?
Would favor adding 4-6 months of ADT.