Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage persistent tumors at the primary and/or nodal site for p16+ tonsilar SCC after definitive chemo-RT?
I would get a first PET-CT and CT with contrast (or MRI, if that was the better study pre-RT) 12-14 weeks after completion of RT/CRT. There are a number of studies on the optimal timing of PET/CT after treatment of p16+ cancers, including a case series published by my team: Wotman et al: 2019. In my...
In rectal cancer in patients receiving total neoadjuvant therapy of FOLFOX followed by 5FU-radiation, is there a role for additional adjuvant chemotherapy based on significant residual disease at time of surgery?
To my knowledge, there is no known role for additional adjuvant treatment in patients with rectal cancer who have received total neoadjuvant therapy with FOLFOX followed by chemoradiation or short-course radiation (SCRT). As of yet, no clinical trials address this situation. Furthermore, there is no...
Is it common to have atypical squamous cells on pap smear s/p chemoradiation for anal cancer in a female?
Yes. That's why women with anal cancer should have PAP smears before radiation. I am unsure as to the duration of these changes. My pathologist friends say a few months.
Would you offer palliative radiation therapy for bleeding risk reduction in a patient with large vessel invasion from an intrathoracic tumor who requires anticoagulation?
Hi. Based on what you present here..."Exsanguinate" comes to mind for me in this instance. I can recall one lung ca patient who had such a final event early in my career. And I have seen some in-patients with advanced Head Neck cancers go out that route. It can be quite disturbing to some / unsightl...
Would you consider radiation therapy for ovarian dysgerminoma with residual lymphadenopathy after chemotherapy?
I would not as behavior like seminoma and most of the time turns out to be a desmoplastic reaction. You can consider a PET/CT as it has high negative predictive value. But if pet positive, it could be false positive and would monitor with serial imaging rather than treat and, if needed, consider for...
What maximum dose would you allow to the orbit in the setting of adjuvant radiation therapy for an excised squamous cell carcinoma of the cheek with orbital bony infiltration and positive margin?
I am also generally aggressive in this scenario given the high risk of local and perineural failures. If the location is the infra-orbital cheek and there is any microscopic PNI, I would cover the ipsilateral V2 to FR. If there is clinical PNI, I trace the nerve back to Meckel’s cave. For V2 tracin...
For prostate cancer, when do you pursue a biopsy for metastatic disease to the bone found on imaging study?
Presuming the patient has undergone curative care for his prostate cancer, and had become undetectable via PSA, who now presents with bone metastases, when would I consider a bone biopsy? So, if he was treated for cure, and had an undetectable PSA on his most recent follow up visit, my question beco...
Is there any role for palliative radiation in the treatment of pericardial metastases?
I love these “have you ever” questions. Somehow, as you get gray in the hair and long in the tooth, you’ve done about every weird thing and I have done a few very crazy cardiac mets over the course of my career. I was on a publication for one of the wildest ones: Kazemi et al., PMID 31993571. I’ve a...
Do you recommend prophylactic cranial irradiation for ES-SCLC patients now that immunotherapy is included in the treatment schema?
I do not pursue PCI for most patients with extensive stage SCLC. We know the EORTC phase III study led by Ben Slotman (NEJM 2007) showed a decrease in the cumulative risk of brain metastases that translated into a survival benefit. One of the flaws of the study was the lack of baseline and regular M...
Are there particular subgroups of patients with glioblastoma who derive the most benefit from TTFields?
No validated subgroup has been identified. Patients with MGMT methylated tumors appear to gain most from treatment, but the EF-14 study was not powered to answer that question and patients with unmethylated tumors still saw a benefit. I recommend TTfields to all patients with newly diagnosed gliobla...