Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are you using prostate PET imaging for any newly-diagnosed prostate cancers?
December 2021 Update:In 2 years since this original post, a lot has changed. Two different PSMA PET/CT companies have gained FDA approval with broad indications that include the use in newly diagnosed men at risk for harboring metastatic disease. Distribution is well underway with many centers now h...
What would be your recommended adjuvant treatment approach for a completely excised lymphoepithelial carcinoma of the right nose recurrent in a left level IB lymph node, status-post excisional biopsy?
Lymphoepithelial ca refers to undifferentiated ca with lymphocyte infiltrates common in the nasopharynx and salivary glands, and in this patient it likely arose from nasal minor glands. The prognosis of patients with this histology arising in the salivary glands is usually quite good after surgery a...
Would a history of receiving green light laser therapy for BPH change your management of newly diagnosed prostate cancer?
Your intervention will depend on his prostate cancer risk group, if he has a 'huge' prostate still, and bothersome LUTS. It will also depend on if you are in the private sector, or in institutional / academic setting, too. For some, the risk of prior "TURP" like procedures are a contraindication for...
How would you approach neoadjuvant chemoradiation in a patient with a history of Crohn’s disease diagnosed with regional lymph node-positive esophageal adenocarcinoma of the GE junction?
Remember that GEJ was evaluated in MAGIC (and more recently, FLOT4) trial. From FLOT4, about 25% of patients were Siewert I, while another 33% were Siewert II/III.Therefore, if concerns about the severity of Crohn's (and potential RT toxicity) are a significant issue, a reasonable treatment paradigm...
Would you consider RT to LNs in a gr 2-3 adenocarcinoma of the lacrimal gland if there are high risk features?
I always irradiate regional nodes. I treat facial and levels 1 to 3. I have seen failures in facial nodes when only levels 1 to 3 are treated. I have seen level 1 failures when only the facial nodes are treated. These are aggressive cancers. I treat with IMRT.
Would you rather start radiation for Stage III NSCLC in the middle of a chemotherapy cycle or wait for the 2nd cycle if it could not be started on cycle 1 day 1?
While we all strive to provide streamlined multidisciplinary care, it may not always be possible to start at the same time. I usually discuss this with my collaborating radiation oncology physician. I usually like to time the radiation on D1 for logistical reasons. RT treatments for stage 3 disease ...
If you are treating a patient with palliative radiation for hemoptysis do you require chemotherapy to be held?
This is an interesting question. I would like to thank @Dr. First Last for his help with this. In recent years, I have rarely found myself asking colleagues from Medical Oncology to hold chemotherapy for patients who require palliative radiotherapy for hemoptysis. That being said, very few such pati...
How would you approach treatment of a posterior fossa metastasis with surrounding vasogenic edema causing mass effect on the 4th ventricle in an asymptomatic patient?
Agree with Dr Chao's answer above on this. In our institution, our treatment of these lesions (in the context of limited mets and no LMD) falls into 3 categories: -preop SRS, usually 15Gy/1fx to the lesion followed by resection that day, sometimes followed by post-op SRS if lesion still felt to be h...
Is it reasonable to only treat the inguinal nodes and not the pelvic nodes in an unresectable cT1cN0 vulvar SCC at the clitoris?
If lesion is superficial one can but if thick lesion based on drainage pattern would favor both inguinal region and lower pelvic nodes
How do you manage acute esophagitis that persists > 1-2 months after completing chemoradiation for lung cancer?
Harsh protracted esophagitis was reported in 4% of Int. O139(1999)i.e., grade 4 regardless of once or twice daily cycle 1 concurrent. CONVERT reports 18% grade 3!or higher, either QD 66 or BID 45. No reports of > 1 mo duration. Consider endoscopy and culture. Empiric carafate and anti-fungal/candida...