Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you give post-mastectomy radiation for a T2N1 triple negative BRCA 2+ patient who had a complete response from neoadjuvant chemo?
When B51 was opened, we offered that. Otherwise, outside clinical trial triple negative with node positive disease recommend PMRT irrespective of response to NACT.
How would you approach treatment of a patient with asymptomatic, oligometastatic basal cell carcinoma?
This is an unusual situation. I would want to clarify whether this is regional versus distant metastasis, and what is meant by "oligometastatic". I would also want the diagnosis of metastatic basal cell carcinoma confirmed histopathologically (and possibly even molecularly) for both a putative prima...
What is an appropriate steroid regimen for a patient treated with RT for spinal cord compression?
I don't believe there is a specific answer to the question; this represents the art of medicine. The highest dose that I recommend is 16 mg of dexamethasone a day. This would be for the patient who has severe neurologic symptoms (weakness, numbness, and/or bladder or bowel symptoms). However, often ...
In a healthy patient >65 years of age with glioblastoma multiforme, what is the recommendation for temozolomide when given concurrently with adjuvant radiation therapy?
Glioblastoma (GBM) is primarily a disease of older adults. The median age of diagnosis is around 60. Many of these patients present with a host of co-morbidities that impact their performance status (PS), overlapping with GBM-related complications. There are multiple scenarios to consider when evalu...
Is it safe to deliver SBRT with concurrent immunotherapy to head and neck sites of progressive metastatic disease?
Yes, have done this many times. Constraints are hard to come by. If it is reirradiation, RTOG 3507 provides guidance, if it is never radiated you have even more leeway.
For early stage TNBC without nodal disease, is a prone breast setup contraindicated due to concerns of suboptimal chest wall coverage?
There is no data to suggest that we need to cover chest wall for early stage TNBC after BCS.
How would you approach patients who have undergone nipple sparing mastectomies with close or positive margins at the nipple areola complex?
We have treated a few patients with adjuvant RT with the same principal of positive margin and literature suggests that nipple areolar complex tolerates RT well with no excessive risk of complex failure.
For persistent PSA elevation after prostatectomy, would you recommend salvage radiation if pathologically negative nodes, but regional and non-regional lymphadenopathy on PSMA PET?
While based on classical staging methods, it appears that he would fulfill the criteria for salvage RT with a persistent PSA, it sounds like this patient has M1a disease by advanced imaging (possibly at presentation). I think that it is very unlikely that he would gain any meaningful benefit from ad...
How would you treat a patient with an keratoacanthoma of the right nasal ala?
In my experience, these patients are treated surgically and radiation does not play a role.
How would you approach treatment of the brain in a patient with ES-SCLC found to have CSF cytology positive for malignant cells but negative MRI of the brain?
A patient with extensive small cell lung cancer that is found to have + CSF cytology cannot be cured. The therapeutic focus should be symptom control and prolonged comfort. The treatment for ED-SCLC is systemic therapy. Commonly, that does not cross blood brain barrier. The question of whether to tr...