Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What role does laser interstitial thermal therapy (LITT) play in the treatment of primary and metastatic brain neoplasms?
LITT is more commonly used for metastatic brain neoplasms at our institution in certain scenarios. It is used for patients with radionecrosis after Gamma Knife/SRS if patients do not respond to steroids or bevacizumab. It is also used for patients with tumor recurrence after SRS in locations that ar...
Do you intentionally modify your breast cancer treatment plans for those on chronic immunosuppression to avoid secondary cancers?
This will usually depend on their clinical scenario. In case where I would recommend RNI, I will still recommend RNI and counsel on risks of second canceers. In patients with early stage lower risk or disease, one can consider partial breast irradiation if appropriate though I do counsel patients th...
For ALK+ patients rendered NED from oligometastatic NSCLC after resection of both lung primary and isolated CNS lesion, do you consider offering treatment with an ALK inhibitor after adjuvant chemotherapy, or do you place into surveillance?
A large proportion of patients with oligometastatic disease managed with curative intent generally relapse, either intracranially and/or extracranially. TKI therapy maybe expected to prolong disease-free/progression-free survival based on our experience with EGFR TKIs. However, given the expected du...
How do you manage the neck in patients with cutaneous SCC who are at high risk of nodal disease but had a negative neck dissection?
First, I would ensure that the appropriate draining lymph node basins were dissected based on the site of the primary tumor. Next, I would review preoperative imaging to confirm that any suspicious lymph nodes prior to surgery were harvested during the surgical procedure. Then, I would review the ca...
How do you define "low-volume" intermediate risk prostate cancer that is appropriate for brachytherapy alone?
For prostate cancer the use of PSA, T-stage, and Gleason score have been used to create multiple different risk stratification schemes. That of @Dr. First Last, the NCCN, and the AJCC are all very similar. In addition, other methods such as the Memorial Sloan Kettering nomograms and the CAPRA score ...
Would you recommend an inguinal node dissection as part of definitive treatment for adenocarcinoma of the anus with suspicious inguinal nodes?
The only wrong way to approach this is with initial inguinal surgery. I have seen that result on multiple occasions in dermal lymphatic recurrence after standard IMRT because the drainage gets altered. True adenocarcinoma of the anal canal has a poor prognosis due to increased rates of distant failu...
What is your recommended radiation field for early stage vulvar cancer with persistent positive margins (T1a-T1b)?
I agree that if the inguinal region has been adequately addressed with negative sentinel node biopsies or with an adequate inguinal node dissection that includes the femoral and superficial inguinal nodes, we would treat only the primary site. However, in these cases, we make an active attempt to li...
What PTV dose heterogeneity do you accept for head and neck radiation plans?
Around 10% but then I'll take the optic chasm to 70 Gy plus in order to adequately treat the tumor. I have a patient under treatment now in that situation. So I do what it takes. If it requires more heterogeneity, so be it.
Would you treat an unresectable papillary thyroid carcinoma metastasis to the nasopharynx with skull base and perineurial invasion with radioactive iodine, radiation therapy, or chemo-radiation?
I would use external beam radiotherapy or even SRS if volume, size and location of the tumor permit. It is unclear if patient's thyroid cancer is RAI avid. Regardless, given skull base invasion, RAI alone may not suffice.
Have the results of LAP07 caused your institution to pursue more aggressive systemic therapy before radiotherapy in the treatment of pancreatic cancer?
Chemotherapy is the standard of care for locally advanced pancreatic cancer. There are two standard regimens, Gem/A and FolfirinOX. These regimens are modestly better then gemcitabine alone, but there is a clear barrier in median survival of 12 months. This will probably never be surpassed with chem...