Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should radiation therapy be offered to the prostate +/- pelvic nodes in a patient who had PSMA PET/CT positive pelvic LN and prostate disease that resolved after a year of ADT?
Difficult to say but.......PSMA (Prostate specific membrane antigens) PET scans, are undergoing active clinical trials is seemingly the way of the future for imaging in most PCs cases as opposed to the current use for Axumin PET scans which are used for PSA progression only, to date. In this patien...
Would you offer post-operative radiation to a patient with a parotid basal cell adenocarcinoma after a negative margin resection?
Depends on grade. I think they are usually low grade so no. Anything high grade and adenoids cystic carcinoma, yes.
What are the current recommendations for androgen blockade for patients undergoing salvage radiation after prostatectomy with PSAs between 0.6 and 1.5?
Just be a little careful here. Although Dr. Spratt did an amazing analysis and thorough presentation of the subgroups, one shouldn't look at PSA <=0.6 as a "cutoff". As Dr. Spratt pointed out in his presentation, the population on RTOG 9601 was mixed in terms of prognostic features.. Would you reall...
How often do women develop HPV associated oropharyngeal cancers?
HPV associated Oropharyngeal SCC is much more common in Men than Women, nearly 3-4 times higher. One possible explanation is higher prevalance of HPV virus in female genitalia as compared to men, however, biological differences in viral clearance may also be a factor. Although, the incidence of HPV ...
Would you omit a lumpectomy boost in a patient with a single positive sentinel lymph node, with a primary tumor that is otherwise favorable?
For luminal A breast cancer like her benefit of boost is very limitedm as IBTR is 1-3% and sentinel nodal status would not influence decision not to boost.
In patients with rectal cancer receiving neoadjuvant chemoradiation, how does possible seminal vesicle involvement on MRI affect the contours of your target?
I would include the entire seminal vesicle with a margin and add the external iliac nodal region in prophylactic volume.
How do you approach early stage, mixed histology lung cancer (SCLC and NSCLC components) in patients with good performance status?
Certainly the simplest approach for an early stage mixed SCLC/NSCLC would be upfront surgical resection and node dissection (provided that good performance status implies medical operability), and then pathologically if a true small cell component is confirmed (or if the patient is found to be node ...
Would you hold off on whole brain radiotherapy for a patient with metastatic NSCLC and multiple asymptomatic brain metastases and will be starting immunotherapy?
This is a very controversial area right now (as are most MedNet queries!). Given the data available and the opinion pieces by thought leaders right now on immunotherapy results in melanoma brain metastases, it would be very reasonable to hold off on WBRT for patients with asymptomatic melanoma brain...
How do you manage pelvic pain and hematuria due to recurrent high grade transitional cell bladder cancer who had received 70 Gy to bladder and is not a chemotherapy or surgical candidate?
It depends whether these symptoms are caused by radiation, recurrence, or both. One might not be able to distinguish. For hematuria I think a cystoscopy and focal fulguration if that is available to the patient, or else consider hyperbaric oxygen therapy, which may also improve pain (I don’t think h...
Would you skip adjuvant RT in post prostatectomy patients?
I suspect that once the paper is published and we get a chance to review the data that we may begin to hold off on routine use of adjuvant RT for prostate cancer patients after radical prostatectomy with higher risk features. That said, it should be noted that the study did randomize to early salvag...