Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you create the boost fields for a definitive bladder cancer treatment?
"Map out the tumor position three dimensionally with the urologist and use all available imaging" is what they say and then after locating it/contouring it, you have to treat with a full bladder. Early in my career, I attempted this and had two issues: Localization is harder than you think. If it...
For Siewert 3 locally advanced GEJ adenocarcinoma, when do you offer preop chemoradiation (CROSS regimen) vs periop chemotherapy (MAGIC or FLOT)?
Siewert I/II GEJ adenocarcinomas are treated according to esophageal cancer algorithms, while Siewert III GEJ adenocarcinomas are treated according to gastric cancer algorithms. Consequently, perioperative chemotherapy with FLOT is the standard, evidence-based approach for fit patients with Siewert ...
When treating sialorrhea in ALS patients, what treatment schedule do you use?
This is what our institution does. I utilized this a few months ago. Kasarskis et al., PMID 21726879
Would a patient receiving intravitreal avastin have a contraindication to prostate radiation?
There may be some systemic effects but not enough for us to hold adjuvant RT.
In a patient with solitary metastasis skin/subcutaneous wrist, resected with graft, from a primary breast angiosarcoma, what would be your preferred fields and dose?
Agree, odd presentation. Hopefully, the patient was fully staged with PET and MRI brain after this was diagnosed to confirm solitary metastasis. If so, agree with chemo first; angiosarcoma in general, has formidable DM risk (though hard to know how much that applies to this presentation) so makes se...
In light of the recent MSKCC Phase 2 data indicating reduced skeletal events with treatment, how will you approach management of patients with asymptomatic bone mets?
It sounds promising, but there is not enough information about the cohort for me to make an informed assessment. One problem I have is that bone metastases from different primary malignancies really shouldn't be grouped together. It's a good starting point for more investigation, and I look forward ...
Would you offer palliative re-irradiation to the sacrum for a patient with a prior history of RT for rectal cancer?
Local recurrence of rectal cancer is still a quite common situation we see in the clinic. Presacral space lesion with sacral involvement is one of the most common scenarios. As a tertiary center, we have quite a few cases with locally recurrent rectal cancer. All these patients are evaluated by a mu...
Is there any data for prophylactic use of lymphedema sleeves during breast radiation?
The current data doesn’t suggest any benefit of prophylactic treatment but does show screening, and early intervention for any sign of subclinical lymphedema helps reduce the clinical lymphedema.
Do you utilize a constraint for skin/dermatitis in setting of thoracic chemoradiation?
No. This acute toxicity is almost universally reversible in short course and should have essentially no bearing on the decision making when treating a potentially lethal lung cancer; also, I know of no data quantifying skin tolerance doses.
For a patient with localized high risk prostate cancer with high risk Decipher score receiving ADT and abiraterone, is there any value of continuing ADT and abiraterone beyond two years?
Since the trial (STAMPEDE) stopped abi at 2 years, that is the longest duration that I use.In the mHSPC setting, we are seeing many patients stay on their first-line treatment for many years (often longer than 2 years). This has made me more cognizant of the long-term effects of abi/prednisone (acce...