Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For what stages of primary vaginal cancer do you typically recommend concurrent chemotherapy with external beam radiation therapy?
We follow the same principal as cervical cancer and offer CRT for stage II cancer and greater, as well as, for node positive disease. We looked at NCDB database and there was increasing use of concurrent chemo for vaginal cancer with positive effect on survival
How should RT be combined with immunotherapy to generate an abscopal response?
This is a difficult question to answer because cancer "immunotherapy" is really a variety of heterogeneous therapeutic approaches. Nevertheless, I am aware of no consensus that specifies the optimal radiotherapy dose, fractionation, timing, or target, when used in conjunction with any specific form ...
When do you recommend a breast MRI for breast cancer surveillance?
MRI is a routine part of the work up (this would not be screening) for women presenting with axilary nodal disease and occult primary. In the era of MRI the incidence of so called occult primary has gone down becuase of higher sensitivity of MRI As far screening is concerned, it is approved for high...
What is the best way to discuss an early palliative care referral with a patient?
Patients (and providers) often struggle with the assumption that palliative care implies end of life care. While that is true in many cases, if you can overcome this false assumption, your patients can benefit. I often explain that palliative care like this: Palliative care serves as an extra set of...
In what situations will you defer SRS for newly detected brain metastases in a patient with an oncogene driven malignancy?
We have deferred RT only in situation where there is open clinical trial (we had one with oral Her2 new agent for asymptomatic brain metastases and there are other ongoing studies). Outside of a clinical trial, we offer RT upfront rather than waiting for response from systemic agent.
Should patients receive PMRT if they just have a positive internal mammary lymph node on imaging and a negative axillary dissection?
I also agree with treating all the regional lymph nodes areas when IMN is positive and axilla is negative. Although a lot of data point towards the risk of having positive IMN increases with the presence of positive axilla, there are situations where the axilla is negative and the IMN is positive (d...
How should radiation oncologists respond to the recent meta-analysis concluding that prostate cancer-specific mortality is lower following prostatectomy vs radiation therapy?
Prior comparisons that suggested equivalence with surgery and dose escalated RT focused on biochemical control. However, with longer follow-up, comparative studies suggest superiority for surgery over EBRT for the harder endpoints of metastasis and cause specific survival. This is most evident among...
What SRS dose do you use for secreting and non-secreting pituitary adenomas, respectively?
In general I go to a higher dose for a secreting pituitary tumor than nonsecreting tumor. I try to go as high as I safely can while respecting optic nerve and chiasm tolerance.
In what situation, if any, should a proton boost be used to boost gross disease in head and neck cases?
Good question. It reminds me of when IMRT was newer, and our practice at UCLA was to give 5 weeks of 3D conformal radiation to whole pelvis, reserving IMRT for the prostate boost portion.@Dr. First Last and I looked at the outcomes, and they didn't seem much different, toxicity-wise, than those who ...
Is there any role for adjuvant radiation for a low grade, intraductal papillary mucinous neoplasm (IPMN) of the pancreas after resection with a positive pancreatic margin?
There is no defined role for adjuvant treatment of IPMN with or without positive margins. This question illustrates an interesting concept that can be applied now that we are in the era where ablative doses of radiation can be given*. Regardless of the tumor site, the margin in question is not near ...