Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you avoid adding high energy photons (with associated neutrons) for younger breast cancer patients, out of concern for secondary malignancy risk?
We used mixed, whenever appropriate, with optimization of dose distribution using field within field technique (no wedges).
How would you approach an early inguinal recurrence after surgical resection of Merkel Cell carcinoma in the popliteal region?
I would make sure there is no distant metastases with a PET-CT. Would try to enroll this patient in a trial. Current approach if localized in surgery followed by radiation, but with availability of immunotherapy, I would recommend at least an adjuvant immunotherapy after surgery. No one knows if rad...
How would you treat and delineate target volume for a pT1N2 NSCLC after wedge resection with clear margins?
In a patient who has undergone a wedge resection and who has negative margins, I do not see an indication for radiotherapy to the residual primary site or staple line, inasmuch as the surgical approach is not standard of care in operable patients. If wedge is done in a high risk operable patient, I ...
How would you approach the treatment of a patient with a history of cutaneous melanoma and only overt site of disease being a bulky level III axillary lymph node?
Surgery and postop RT.
What dose-fractionation scheme do you recommend for the treatment of leukemia cutis?
Leukemia cutis (LC) is a form of cutaneous extra-medullary leukemia that confers a relatively poor prognosis, with a median survival of <12 months. Since most of these patients have additional sites of involvement (spleen, liver, CNS), the mainstay of treatment of EMD leukemias is still considered t...
What is your hemoglobin transfusion threshold for asymptomatic pediatric solid tumor patients during radiation?
We aim for a Hb of 10g/dL whenever possible. This is not based on any data from pediatrics, but from data in adult patients (Prognostic value of hemoglobin concentrations and blood transfusions in a retrospective study of 386 patients).
In a patient with newly diagnosed anal squamous cell carcinoma, who has an extensive history of active autoimmune disease including Crohn's, Lupus, and arthropathies on multiple therapies, would you forgo radiation therapy and proceed to APR upfront?
I've treated patients like this with standard chemoradiation, and while the GI toxicities are certainly increased, we have gotten them through curative treatment with aggressive symptom management. I would carefully counsel patients on APR vs increased risks of chemoradiation in the autoimmune conte...
Can liquid biopsy be substituted for tissue biopsy in a lung mass that is radiologically suspicious for primary lung cancer when CT-guided biopsy cannot be done?
Generally, the utility of liquid biopsy remains in the ability to provide genomic information from cfDNA. A liquid biopsy will not provide a definitive tissue diagnosis and does not provide information about histology. When a histologic diagnosis is made with biopsy or FNA but the sample is insuffic...
Do you stop treatment for a prostate cancer patient diagnosed with acute radiation proctitis with significant pain?
I would first check the treatment fields and treatment setup to ensure that there isn't excessive dose going to the anorectum. As with all toxicities in radiation oncology, one must exclude other possible reasons for the anorectal pain such as hemorrhoids, infection, or inflammatory bowel disease. I...
How do you counsel patients who are candidates for a clinical trial regarding their options?
I typically discuss the option with patients as early as possible in their diagnosis, and explain that at some point during their treatment they may become a candidate for a clinical trial. I discuss resources to look into clinical trials and what they mean for patients. We discuss patient website r...