Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For patients with a history of seizures secondary to brain metastases, what are your criteria for discontinuing antiepileptic medications if the seizures have been controlled since SRS or surgery?
Brain metastases patients are discussed at our multidisciplinary brain metastases tumor board whether they have received SRS, surgery or WBRT. In general, I like to keep antiepileptics for up to three months in patients who have seizures that are controlled. Factors that I consider for discontinuing...
Do you treat the ipsilateral neck and primary site for a resected skin cancer with parotid mets?
Yes, assuming primary site from skin was resected within 2-3 yrs of the parotid met presentation AND, it is in close proximity to the parotid - that it could be addressed using a small electron field matched with the parotid fields. In that case, I would include the original skin site together with ...
What is the appropriate follow up after chemoradiotherapy for patients with anal SCC?
A few points of note. First, the evaluation of the primary site is usually better done by a physical exam than by any imaging study. Therefore, a careful rectal/anal exam is essential at each follow-up. I will usually observe residual abnormalities in the canal as long as it is regressing and there ...
How do you manage adult brainstem lesions in the absence of a tissue diagnosis?
I would: Discuss with the neuro-radiologist and obtain another imaging study(e.g. PET or MR perfusion) that could support the MRI diagnosis of high grade glioma. Have a thorough discussion at a multi-disciplinary neuro-oncology tumor board to make sure surgical biopsy is unsafe and there is consens...
What post-treatment imaging do you recommend for glomus jugulare tumors (paragangliomas) following definitive radiation therapy?
MRI or CT 6-12 months post-RT assessing for stability in tumor size or possible tumor regression. MRI will help show a reduction in flow voids, decreased heterogeneous enhancement, and a reduced T2 signal. Studies have demonstrated tumor regression in 57% to 73% of patients followed by CT as well [S...
Do you routinely recommend patients with spine metastases wear neck collars or back braces?
The neurosurgeons here do not believe that collar and brace for metastasis should be applied routinely, even inpatients with pathological fractures. The issue with these collars and braces is that it makes the musculature weak and often times they develop worsening pain and instability because of it...
How do you manage the timing of adjuvant therapy in a patient with a glioblastoma and a post-operative surgical site infection?
There have been several studies on the timing of adjuvant therapy for glioblastoma including our institution https://www.ncbi.nlm.nih.gov/pubmed/26440447. In general, our practice has been to start adjuvant radiotherapy as soon as reasonably possible. If a glioblastoma patient has postoperative surg...
Do you routinely hold immunotherapy during whole brain radiation?
I don't routinely withhold immunotherapy during whole brain radiotherapy but would look at all aspects of the case including performance status, labs, goals of care, etc.. Alternatively with SRS I don't routinely withhold immunotherapy as well.
How do you manage SCC metastasis to the parotid with unknown primary?
Guidelines for this situation have been published:https://www.ncbi.nlm.nih.gov/pubmed/22076982After ruling out the possibility of a mucosal primary, in the setting of a presumed occult cutaneous squamous cell carcinoma, I would typically suggest parotidectomy, with regional lymphadenectomy (for pati...
Can short course radiation therapy (5 Gy x 5 fractions) be given for low lying rectal tumors, near the sphincter but not involving it?
The anal sphincter toxicity of short-course radiation therapy versus long-course chemoradiation therapy is an interesting question. We know from a robust experience in anal squamous cell carcinoma that long course radiation does carry a significant risk of sphincter tone issues in the long-term, eve...