Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel patients on control of glioma-related seizures following radiation?
About a third of malignant glioma patients present with a seizure, another third of patients will eventually develop seizures, and the last third never have seizures. Curiously, seizures as a presenting complaint carry a BETTER prognosis than those with focal neurologic deficits at diagnosis. The im...
How do you manage patients on atezolizumab/bevacizumab with advanced HCC who develop arterial thrombosis?
I would stop bevacizumab if there is arterial thrombosis and start anticoagulation, continue single-agent atezolizumab. Would not stop the bevacizumab for portal vein thrombosis as it is most of the time a tumor thrombus.
How would you modify adjuvant radiation for oral cavity SCC based on the presence of sarcomatoid features?
Suggest to discuss the sarcomatoid features with the pathologist. There are two possibilities:1. Spindle cell carcinoma is a variant of squamous cell carcinoma characterized by spindled or pleomorphic cells that appear to be sarcoma but are actually epithelial. Some of these can be HPV-related and h...
Would you use a PSMA test obtained as part of a clinical trial to alter your treatment management?
If PSMA is being obtained as part of a clinical trial protocol, the protocol would specify how the information would be used. PSMA should be thought of as just a more sensitive PET Axumin scan. When PSMA is approved by the FDA (and gets paid for), it will likely replace PET Axumin in staging for pat...
What radiation dose would you use when giving definitive chemoradiation for inoperable rectal cancer with extensive invasion into gluteal musculature?
A rectal cancer this aggressive is not easy to control. Surgeons tell me the surgical options are not promising. Assuming this is a new diagnosis, I would employ a total neoadjuvant approach. I would start with chemotherapy in this case (not 5x5 followed by chemo a la RAPIDO). After 4+ months of che...
How would you adjust your supraclavicular field, if at all, for a patient with a remote history of receiving radioactive iodine ablation for thyroid disease?
I wouldn't make any adjustments. Thyroid damage is not a concern. Standard angled fields are off cord.
How do you treat a primary pineal neoplasm of intermediate differentiation?
Pineal parenchymal tumors of intermediate differentiation (PPTID) represent a rare type of intracranial tumor that behaves somewhere between pineocytomas and pineoblastomas. Given the rarity of PPTID, data is limited to retrospective studies with no clear consensus on adjuvant therapy. In general, a...
What adjuvant treatment would you recommend for Stage III vulvar cancer s/p resection with a history of prior radiation treatment for vaginal cancer?
My answer depends on the specifics of the case. Would be important to review the fields and doses. Also depends on what the perineum looks like. Are telangiectasias present with thinned epithelium consistent with significant RT dose? If the previous vaginal lesion involved distal 2/3 of the vagina, ...
Is there a role for surgical resection in parameningeal rhabdomyosarcoma either at diagnosis or following initial therapy w/ VAC at week 12?
Not really. For rhabdomyosarcomas outside of the head and neck region, surgical resection often plays an important role in the treatment paradigm. However, given the anatomical constraints with paramenigneal tumors, gross total resection is often not possible without resulting in significant morbidi...
How would you manage adjuvant therapy in a gross totally resected favorable site embryonal RMS with resected positive lymph nodes?
The paratesticular site may be different and I think controversial. At ASTRO 2020, St. Jude/Dr. @Dr. First Last presented results from its phase 2 trial on RMS in which they did not deliver adjuvant RT to the primary site in which a DPE was performed with negative margins and the control appeared go...