Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach local control in a patient with extra-osseous metastatic Ewing sarcoma of the kidney?
I would follow general guidelines for Ewing sarcoma – if the tumor is completely resected, no RT. If spread outside post surgery, then would follow Ewing Sarcoma dosing guidelines.
In a patient with stage III NSCLC who was treated with neoadjuvant systemic therapy and had a PR, would you deliver RT to all sites of initially involved disease, or only residual sites of disease?
I struggle with this one quite often. The data would suggest that you need to treat all initial sites, but of course, that's not the purpose of those studies (defining what sites, dose to sites, etc) and there's almost assuredly something going on with that aspect of the therapy. The other way to th...
What is the role for consolidative ISRT for patients with stage III follicular lymphoma following a good response to systemic therapy?
Advanced (stage III-IV) follicular lymphoma is not considered "curable" with either chemotherapy or immunotherapy (or the combination). A complete response may be achieved but an eventual relapse is inevitable. For patients who are asymptomatic without bulky or threatening disease, current guideline...
What is the role of radiation therapy in a patient with diffuse cutaneous melanoma metastases who cannot tolerate systemic therapy?
The role of radiation therapy in diffuse cutaneous melanoma is palliative.
Do you use adjuvant radiation therapy for low grade biliary neuroendocrine cancer with positive margin?
Yes.
How do you manage asymptomatic radiation necrosis in a glioblastoma?
If a patient is not symptomatic from radiation necrosis, the only thing that would make me consider initiation of dexamethasone (Consideration of Avastin reserved for symptoms refractory to steroids) would be significant midline shift that is progressing, but this is usually going to lead to symptom...
Would you consider continuing a biologic for difficult to control autoimmune disease in a patient with a recent diagnosis of a surgically curable solid malignancy?
There continues to be relative uncertainty regarding the management of biologic therapy in these patients. As treating physicians, this scenario is not uncommon where a decision to continue or stop a biologic has to be made in face of solid malignancy. A detailed review of individual circumstances t...
In a patient with a remote history of mantle field radiation, is there any contraindication to whole breast irradiation for early stage breast cancer?
It’s not an absolute contradiction depending on prior mantle dose and volume. That being said, would favor PBI over whole breast if disease suitable for PBI. One concern about the risk of new primary at other site in breast remains as had mantle RT and a need to be counseled.
How long do you wait before performing liver-directed therapy on a colon cancer patient with liver-only disease and prior radiation-induced liver injury ?
How long after completion of radiation therapy should patients continue fluoride treatment for dental health?
Indefinitely