Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient with newly diagnosed locally advanced NSCLC and concurrent, active tuberculosis on anti-TB therapy?
Excellent question @Dr. First Last! Assuming the patient is otherwise a good candidate for concurrent chemoRT, my bias would be to proceed with concurrent therapy once the 3 negative AFBs are available, rather than pursue sequential RT then chemo. This recommendation is based upon the observation th...
How would you set up and treat a mycoses fungoides patient with symptomatic bilateral inner thigh, groin, and scrotal plaques?
The upper inner thighs, inguinal skin folds, gluteal cleft, and much of the genitalia are typically under-dosed during a course of total skin electron beam therapy. If there is gross disease in these areas, a localized RT "boost" is generally necessary. Unfortunately, these areas are some of the mor...
How do you approach radiation for a locally advanced prostate cancer with caudal extension into the penis in a patient?
When I have encountered this problem, it has either been a very locally advanced adenocarcinoma or small cell. I'll assume for this question that your patient has an adenocarcinoma. Long-term ADT is probably going to be part of the picture, depending on the Gleason score. I consider the extension in...
How would you manage a patient with localized prostate cancer treated with radical prostatectomy and found to have a single involved pelvic lymph node on final pathology and a detectable postoperative PSA?
This patient is now in the salvage setting with PSA recurrence after RP and with PSA persistence and node-positive disease. This is a grey area of medicine without level 1 evidence from RCTs but there are some sources of data to help guide optimal outcomes. This patient is at high risk for further m...
How would you approach a BRAF negative metastatic melanoma patient on immune checkpoint inhibitor therapy with enlarging, symptomatic brain lesions that had previously been treated with SRS?
Depending on the PS and medical history of the patient, would recommend moving them to ipi (3 mg/kg)/nivo (1 mg/kg) as soon as possible. - Brent Hanks
Is there a role for external radiation and/or brachytherapy in stage IVB vaginal cancer aside from palliation?
I would offer palliative RT. Quad shot to the site of symptomatic disease (primary and gross node).
Would you offer definitive radiation therapy for a Merkel cell carcinoma in which surgical resection would be disfiguring or result in significant dysfunction?
I would, but after an appropriate discussion. First, I favor full staging of all Merkel cell patients with a PET/CT (though many would argue this is not mandatory for small tumor, node-negative patients). I would also recommend a sentinel node procedure because the risk of nodal disease is significa...
Can the inguinal and pelvic nodal RT be omitted for FIGO IVA unresectable vulvar cancer with a negative bilateral inguinal nodal dissection?
In my opinion, the answer is a qualified "yes." Has the patient had a PET scan that is negative, except for the primary vulvar lesion? If so, this argues in favor of omitting inguinal and pelvic LN's since the negative predictive value of PET for adenopathy in gyn cancers is consistently reported to...
What kidney constraints would you use for a patient with horseshoe kidney?
It depends on the clinical scenario (treating pa region prophylactic or definitive). If prophylactic, then be more conservative and plan for a mean dose of less than 10 Gy (16 Gy volume to less than 5 percent). If gross disease around, then the mean dose can be higher but try to focus on the highest...
When would you consider adjuvant chemoradiation in a patient with esthesioneuroblastoma?
In both situations, I would give cisplatin concurrently with post-operative RT. One could make an argument for the combination regimen as this is a rare tumor lacking in randomized controlled phase III trials to establish standard of care. Multimodality management is extrapolated from HNSCC and neur...