Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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 ...
Would you add concurrent chemotherapy to definitive radiation based on suspicion for extranodal extension (ECE/ENE) on imaging (adjacent fat stranding) for a clinical T1-2N1 (single node < 3cm) oropharyngeal cancer?
Yes.
Is there a contraindication to orthodonture in an AYA after high dose head and neck radiation where the mandible got close to full dose (e.g., 60 Gy for nasopharyngeal carcinoma)?
I don't consider prior H&N radiation as a child or adolescent as a contraindication to forms of orthodontics. Having a dental professional with some experience in higher risk dentistry may be of benefit. During times of active imaging (e.g. the first 3-5 years post treatment), there may be a need to...
Would you treat a small focus of PET/Axumin uptake just below prior field of salvage prostate bed radiation just below a vesico-urethral anastomoses?
First, I assume there is a PSA recurrence and the patient has no evidence of disease outside of that one nodule. I would first look at where the inferior edge of the initial post-prostatectomy field ends. The RTOG consensus guidelines recommend the inferior edge of the CTV to be 8-12 mm below the ve...
In LS-SCLC, for a patient with positive mediastinal LN but PET negative ipsilateral hilum, would you treat the hilum?
I generally agree with Dr. @Dr. First Last, however, it would depend on the location of the primary tumor. If the dose to the primary treated part of the hilum, I would treat the hilum more comprehensively. This just because it would be so difficult to go back should the tumor fail there. I agree th...