Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is it reasonable to treat with RT alone for limited stage SCLC if unable to receive chemotherapy?
Yes, I think this is reasonable, though obviously expectations should be tempered, as SCLC is essentially a systemic disease and as such, RT alone should be viewed as palliative treatment or aimed at preventing imminent morbidity from local progression. I would consider a hypofractionated regimen su...
Would you consider a cisplatin-based regimen with hypofractionated radiation for bladder cancer?
Yes, with bladder only RT almost any chemo regimen is acceptable, including cisplatinum, Gemzar, or 5FU and MMC.
Is there an increased risk of pneumonitis in COVID-19+ patients receiving lung irradiation?
This is still very much an open question, since COVID-19 has not existed long enough for us to assess the full impact of the virus on radiation pneumonitis/fibrosis risk. It may be challenging to accurately determine the primary etiology of lung-related changes for COVID-positive patients who receiv...
How do you determine whether to treat a young adult with stage IA Hodgkin Lymphoma with the adult or pediatric treatment paradigm?
There is a long history of pediatric protocols for HL differing somewhat from the adult ones, but not much biologic rationale to support this, as the disease in young adults is biologically the same as in pediatric patients. Side effects of RX may of course differ, particularly with regards to RT an...
How do you balance target coverage with tolerances of the ipsilateral eye structures and the risk of vision loss in advanced head and neck cancers?
My personal approach is to always recommend induction systemic therapy for T4b unresectable disease with orbital invasion. If it is at all resectable (T4a), I agree with offering curative surgery (including enucleation) upfront or induction if that is a surgeon preference, then post-op chemoRT or RT...
How do you manage intracranial metastases from gestational trophoblastic neoplasia?
High risk gestational trophoblastic neoplasia with brain metastases is rare, and treatment has evolved over the past few decades and centered on multi-agent chemotherapy. The most well-cited regimen is EP-EMA (etoposide, 150 mg/m; cisplatin, 75 mg/m, intravenous, day 1; etoposide, 100 mg/m; methotre...
For T2-T3 N+ rectal patients with large (2+ cm) bilateral sidewall nodes outside the TME volume, should you extend elective nodal volumes anteriorly to include external iliacs?
No, I would not routinely extend elective nodal volumes anteriorly to include external iliac nodes in a patient with T2-3 N+ disease and large bilateral sidewall nodes outside the TME volume. Lymphatic (and venous) drainage of low and mid rectal cancers includes internal iliac (pelvic sidewall) and ...
Would you offer radiation therapy to the prostate in addition to up to 1-3 osseous metastases in a patient with newly castrate-resistant oligometastatic prostate cancer, with no prior treatment to the prostate?
I would not treat the prostate except for palliation of local symptoms. There is no proven benefit of local RT for castrate-resistant prostate cancer.
Should patients about to start radiation be required to have COVID-19 testing, if resources are available?
We are also pre-testing all procedural cases using PCR, but are doing symptom/question screening for all outpatients, not allowing visitors outside of special situations, and maintaining social distancing in the hospital (decreasing areas for patients to sit) so they are forced to remain apart. The ...
Would you consider short course RT for rectal cancer in the post-op setting given COVID-19?
I would not use short course in the postoperative setting. Virtually all of the data on short course are preoperative, where most of the irradiated bowel is removed surgically. The patient would get over the acute reaction from short course postoperatively, but I have major concerns about late effec...