Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you do approach treatment of a recurrent gliosarcoma?
Primary gliosarcoma remains a challenging clinical conundrum. There are no curative therapies and little to no high level evidence to guide decision-making. Most approaches have followed patterns similar to those used for recurrent glioblastoma. The outcomes are usually poor. However, it does help, ...
Does microscopic ENE warrant post-mastectomy radiotherapy if all other factors are low risk?
With respect to ENE, I first look at axillary surgery. If the patient has SLN+ and microscopic ENE, I do typically offer PMRT even with other low-risk factors. While the IBCSG trial evaluates micrometastases, it's important to remember 90% received lumpectomy, and therefore, most received whole brea...
How do you approach treatment for a patient with uveal melanoma who is not a candidate for plaque brachytherapy
Protons. We use a 4 fraction regimen which is attractive compared with two surgical procedures.
Is tumor deposit (N1c) alone an indication for adjuvant chemoRT for rectal cancer that did not receive neoadjuvant therapy?
Some patients such as this were undoubtedly included in the early rectal cancer trials [GITSG and Mayo North Central (NCCTG)] that established the role of post-operative chemoradiation for stage II and III rectal cancer. However, accrual numbers were too small for stratification of TN subsets and it...
Do you recommend prophylactic ureteral stenting in patients who have recently completed SBRT to a region in close proximity to the ureter prior to the potential development of fibrosis?
No, just F/U MRI.
Do you consider high para-aortic nodes above the renal vessels to be locally advanced or metastatic in cervical cancer?
It sounds like you are asking how aggressively to treat patients with para-aortic nodal spread. My limit for "para-aortic" or "regional LAD" is usually anything below the diaphragm. I generally think of and treat these patients as advanced stage III.I would also advocate for definitively treating ce...
Is it appropriate to use hypofractionation to treat breast cancer when the patient is receiving concurrent TDM-1 (Kadcyla)?
We have been using it routinely with no increased acute side effects and are looking at our data systemically.
What treatment would you offer for a patient with unresectable triple negative breast CA who remains unresectable after completion of dd AC-T?
If the patient was responding to treatment but maybe presented with a large mass and had an insufficient response to chemo to convert her to resectability, further chemotherapy with carboplatin, preferably in combination with another agent - and I wouldn't rule out using docetaxel, given the activit...
What is the optimal management for a patient with Tourette Syndrome with severe tics that preclude the patient from lying still for radiation?
A patient with Tourette syndrome (TS) this significant is likely to have an outpatient neurologist; certainly a discussion regarding medical options to help movement elements in the short-term warranted. While behavioral therapy plays a large role in the long-term management of TS, certain medicatio...
How would you manage a patient with history of stage IIIC HGSOC after secondary cytoreduction of isolated inguinal node recurrence 12 years after primary treatment?
Difficult case. Could just observe if the lymph node is an isolated recurrence with no extracapsular extension. If extracapsular extension, could offer standard chemotherapy again, or just single agent carboplatin to minimize side effects x 6 cycles. This patient should have been extra-sensitive to ...