Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel/treat a locally advanced Stage IIB cervix cancer while patient is 12 weeks pregnant?
This is individualized with discussion with patient about cancer outcomes with a delay of treatment vs. loss of pregnancy.
How do you time same-day chemotherapy and radiation for patients undergoing concurrent chemoRT?
A great question. It is similar to recipes for pasta sauce - with rare exception no matter how you make it, it's usually good. There are retrospective data which suggest that capecitabine is most effective one hour prior to RT. That is the ideal sequence. However, since it is prescribed q12 hours it...
What volume would you treat after solitary axillary nodal recurrence after previous lumpectomy in a breast cancer patient without prior radiotherapy?
There's no perfect answer, but in most circumstances, I would favor treating the whole breast as well. An axillary recurrence suggests that there is at least some risk in the residual lymphatics of the breast. In the modern era of planning, in most circumstances, the breast can be treated without ad...
Are total abdominal radical hysterectomies preferred over laparoscopic hysterectomies in early cervical cancer?
Its interesting question and answer probably is not known. MIS showed higher loco regional relapse and conclusion was surgeon need to be cautious and discuss with patient pros and cons of this approach. About 15% had robotic surgery and believers feel they get wider access with robotic and they woul...
How would you manage a patient who presented with synchronous squamous cell carcinoma of the anus (cT2N0) and adenocarcinoma of the rectum (cT3N0) at 7cm from the anal verge?
There is clearly no "correct" answer to questions such as these. However, a reasonable approach would be to treat as one would treat an anal cancer with pelvic RT with 5-FU and mitomycin C and then follow with a low anterior resection for the rectal cancer. If this were a small T2 cancer it would be...
How do you approach an AVL (atypical vascular lesion) of the breast?
I would favor excision (presuming post EBRT) as there is some suggestion that they can transform to angiosarcoma.
What is your recommended dose and treatment volume for multifocal glioblastoma involving the bilateral cerebral hemispheres?
Median survival of multifocal/multicentric GBM is only about 5-10 months across series, and a recent study reported 2-year survival only 4% (PMID:22920963). Optimal radiation dose will depend on performance status, neurologic status, comorbidities, age, and social situation. Reasonable doses are:- 0...
In a medically inoperable, elderly, frail patient with muscle invasive, node negative bladder cancer, would you consider combining immunotherapy with radiotherapy instead of chemotherapy?
Maybe but what about using low dose Gemcitabine ( 27mg/M2 twice weekly) with daily XRT as in NEG 0712? This seems much better to me! WS
How do you manage adjuvant hormonal therapy in a patient with high risk prostate cancer who already received prolonged neoadjuvant ADT prior to being referred for radiation?
For the purpose of answering this question, I will assume that the patient has a stable or declining PSA and has not shown signs of castrate resistance. In general, I am more concerned with the response to ADT prior to beginning radiation, rather than the duration of ADT before RT. Retrospective dat...
How do you approach local control in intermediate risk bladder rhabdomyosarcoma in very young (<24 months) children ?
These two approaches are probably equivalent in qualified hands (cystectomy / prostatectomy or definitive RT) in terms of local control. This issue is balancing morbidity. The surgical approach in many cases will require a full cystectomy, necessitating the creation of a neobladder or some other re...