Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How, if at all, does the presence of hemorrhoidal bleeding affect your radiation recommendations for prostate cancer?
My first quest is to determine what risk group (low/intermediate/high) is the patient in as it relates to the prostate cancer because if it is either of the latter two, ADT will probably be a component of the treatment regime, and this will buy you time to render the afflicted hemorrhoid(s) resolved...
Is there an age cutoff over which you would not recommend definitive radiation for intermediate risk prostate cancer?
In general, I prefer to try to evaluate a patient's physiological age rather than merely use chronological age as an absolute cut off for definitive radiation. Thus, both performance status and co-morbidities factor heavily into my decision whether or not to recommend definitive radiation. In additi...
How do you approach SRS for brain metastases in the presence of cranial hardware?
Cranial plates may be placed that could potentially affect the dosimetry of SRS. Specifically with Gamma Knife, although one can select planning (CC convolution) that could account for the high Z material of the cranial plate, it is felt that the 192 multidirectional beams of radiation would make th...
Is there a role for extended treatment volumes (elective nodal) in the definitive treatment of parameningeal rhabdomyosarcoma in a young adult?
If by "extended treatment volumes" you are asking about cranial or craniospinal radiation therapy, the answer is an emphatic NO. We demonstrated by careful review of patterns of failure that cranial irradiation was unnecessary in PM-RMS (Michalski 2004). The IRS and subsequently the COG have abandon...
Is it safe to irradiate a patient with Cowden syndrome?
I irradiated 1 patient with breast cancer and Cowden syndrome about 25-30 years ago and she tolerated it well without any unusual early or late toxicity
Do you recommend bevacizumab in platinum sensitive recurrences of epithelial ovarian cancer?
Bevacizumab was approved for use in combination with chemotherapy followed by continued bevacizumab maintenance in patients with platinum-sensitive recurrent ovarian cancer in December 2016. This approval was based on the findings of 2 studies, GOG-213 and the OCEANS trial. Both trials demonstrated ...
What margins do you use for glioblastoma in close proximity to critical structures?
Assuming standard fractionation to 60 Gy with concurrent temozolomide, I am struggling to think of a GBM patient who has had a complication due to radiation to adjacent critical structures. Since my GBM margins are not very large (Initial: 1 cm around the T2 + cavity. Cone-down: 1 cm around the cont...
How would you manage an osteosarcoma patient with local disease only and an R0 resection who could not tolerate neoadjuvant chemotherapy?
I wouldn't consider this an indication for radiotherapy, but I would proceed with an alternative chemotherapy. There are many places where the use of MAP is challenging due to limited resources and so alternative regimens are required. We evaluated carboplatin, ifosfamide, and doxorubicin in the abs...
What potential risks of SBRT do you counsel patients on when treating early stage lung cancer with an underlying chronic lung infection?
Interesting problem! I can’t say as I’ve had this exact dilemma. I wish there was a way to post a picture in these questions. I’d be curious to see the lie of this tumor and infection. I’m going to make the educated guess that this is a chronic, highly resistant bacterial infection that smolders alo...
Do you treat atypical carcinoid of the lung with N2 or N3 nodal involvement with definitive concurrent chemoradiation?
I agree that these are very difficult cases due to the lack of data for either radiation or chemotherapy responsiveness in bronchopulmonary NETs. When possible we try to offer surgery. For patients with resectable N2 disease, I would recommend surgery and then consider adjuvant chemotherapy for atyp...