Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of preoperative radiation in patients with bone metastases needing surgical stabilization (ie. ORIF), but without tumor resection?
It depends on the patient’s primary diagnosis, extent of disease (multiple metastases vs oligometastastes), and life expectancy. These factors help us formulate a treatment plan on whether we are going to deliver higher ablative doses for patients with longer life expectancy where the ultimate aim i...
How do you approach a tumor bed recurrence after previous neoadjuvant chemo and cystectomy for bladder cancer?
I would opt for concurrent chemoRT in most instances. Here is my explanation as to why: First, I think it's important to establish that recurrence of bladder cancer after radical cystectomy (RC) usually portends a very poor prognosis; these patients have a median survival of 5.6 months after diagnos...
Is there role for partial breast radiation in a small <1cm low to intermediate grade DCIS with widely negative margins?
If deciding on RT for low risk like the above, then APBI is an option along with whole breast RT with similar efficacy.
How would you treat a patient with urothelial cancer and 25% plasmacytoid variant who has a solitary recurrence in rectum 1 year after neoadjuvant chemotherapy and radical cystectomy?
Plasmacytoid urothelial carcinoma has a very high tendency to develop peritoneal carcinomatosis. And although on scan there could be solitary occurrence, on exploration, may be able to see more peritoneal involvement. Thus, systemic therapy would be a more appropriate strategy to treat. Diamantopoul...
Would you give adjuvant therapy after diagnosis of presumed stage IA, 5cm, ER/PR+ uterine adenosarcoma on a total hysterectomy with bilateral salpingoopheretomy without staging?
We would favor observation with no adjuvant treatment.
Would you offer SBRT for a functional adrenal adenoma?
The treatment of choice for a functional adrenal adenoma is resection. Excellent outcomes can be obtained with a laparoscopic approach. For patients that are not good surgical candidates, SBRT offers an excellent alternative to surgery. Multiple studies demonstrate techniques and safe outcomes with ...
Is it necessary to hold azathioprine in a Crohn's patient receiving breast radiation?
While limited data are available, I have treated patients on azathioprine with breast radiation and have not noticed a substantial difference in skin toxicity.
Would you recommend RT for DLBCL of a pre-isthmus node incidentally found during thyroidectomy for papillary thyroid cancer?
This scenario addresses a relevant question that is occasionally encountered in clinical practice: Is there a role for consolidation RT in a patient who has all gross disease removed surgically? In the LYSA-GOELAMS randomized DLBCL study, 19% (62/327) of patients had a negative PET-CT after surgical...
For breast patients that are clinically node negative based on ultrasound and axial imaging, is axillary radiation an acceptable alternative to axillary dissection in a setting where a sentinel lymph node fails to map?
Standard in this situation is ALND. In the era when anatomy along with phenotype and genomic score drive systemic treatment options, it’s reasonable to do high tangent RT instead of ALND to avoid risk of lymphedema unless systemic treatment would change based on nodal status.
Is there a strong rationale for contouring small and large bowel structures for GI cases of IMRT/VMAT/3D-CRT separately?
It depends on the clinical situation. However, keep in mind that these structures are not all mobile. An example is that the C-loop of the duodenum always retains its relationship to the pancreas. For large bowel, there is relatively little mobility of the ascending and descending colon (although th...