Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you use the highest or most recent PSA for risk stratification for newly diagnosed prostate cancer?
This happens on occasion and can be a dilemma. First, I would repeat the PSA and see if it is <20 or >20, and take that into account. I would also take into account the genomic score. This may help further clarify the patient's risk category. If the patient had a reason for the first elevated PSA li...
Can Trental + Vit E for treatment of fibrosis be used in patients taking anticoagulants?
Vitamin E can definitely increase bleeding and should not be prescribed by a radiation oncologist for a patient on anti-coagulation. However, bleeding is not a commonly reported side effect of Trental. (Though bleeding does make the extensive list of possible complications.) It inhibits phosphodiest...
In a patient who is planned for WBRT for multiple brain metastases but also needs breast palliation, do you favor breast radiation over palliative mastectomy?
Why not concurrent? 30/10 to both. Can add a few more to breast, sometimes I go to 39 Gy/13 fx. If not concurrent (why, though?), then just depends on which seems more bothersome. The breast has probably been there for quite a while, so perhaps address brain and then re-assess.
What is your preferred IGRT strategy when treating breast cancer using IMRT?
For regional nodal patients: we use daily kv CBCT to bone/chest wall on Halycon for the majority of our patients. Our C-arm linacs use daily kv-kv to bone/chest wall for alignment (faster). All patients with VMAT/multibeam IMRT are treated in custom immobilization on a breast board instead of breast...
How would you proceed for a patient with metastatic gastric-type adenocarcinoma, with vaginal and inguinofemoral disease only, who experiences complete response to her vaginal tumor but residual inguinal disease?
There is no ideal data to guide this. I would recommend surgical nodal excision of the residual inguinal disease, followed by pelvic and inguinal radiation (with or without platinum if the patient can tolerate further). Another approach would be with cisplatin-based chemoradiotherapy with treatment ...
How would you design your post-op radiation field for pT4a laryngeal SCC with subglottic extension s/p TL, who has a TE fistula?
PEG and irradiate. The TE fistula won’t be fatal, the cancer will be.
Would diagnosis of a low grade, non-invasive papillary bladder cancer alter your recommendations for salvage prostate radiotherapy after rising PSA?
I would treat with salvage RT as that’s definitive treatment for recurrent prostate cancer and treat non invasive bladder cancer with TURBT and cystoscopic surveillance.
Would you offer neoadjuvant chemotherapy for a large, but recurrent grade 1-2 myxoid chondrosarcoma of knee which is no longer amenable to limb salvage?
While not directly relevant for this patient, it is also important to keep in mind that RT is quite effective in decreasing LF in chondrosarcoma, particularly in anatomically challenging locations like joints/pelvis/spine where wide margins often cannot be achieved. The benefit of RT (HR 0.23 for LF...
Is there an age beyond which you will not perform salvage prostate brachytherapy?
No, I don't have an age limit (upper or lower). However, I would always have a discussion with the patient so I understand his concerns and wishes, and I will always make sure he understands his treatment options, pros and cons of any type of treatment. I will also review his medical co-morbidities ...
How do you approach at-risk draining nodes and the bronchial stump in PORT volumes for margin-positive, pN0 NSCLC?
For a positive-margin, pN0 NSCLC, I would only treat the positive margin region. In a pN0 patient, there would be no benefit to treating the mediastinum prophylactically and there is certainly no evidence for this. One could perhaps make an argument for prophylactically treating regional LNs if the ...