Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you use standard neoadjuvant chemoradiation for a patient with advanced rectal cancer and a history of previous pelvic RT for another cancer?
No. We have to remember that the benefit of radiation in locally advanced rectal cancer is limited to a local control benefit; and must balance the risks/benefits as such. Moreover, there are T3 tumors with an uninvolved mesorectal fascia(1) where the role of radiation may be more limited; since a T...
How would the presence of active rheumatoid arthritis on methotrexate impact your choice of fractionation for a patient with prostate cancer?
It depends on the dose of MTX. For 7.5-10 mg weekly doses have not changed volume or dose but if on a higher dose of MTX then I would discuss with rhematologist for possible holding or decreasing dose of MTX (as in that range has known radiosensitizing effect)
Would you offer RT to a patient with a stage I low grade follicular lymphoma in the groin/upper thigh (7 cm) s/p complete excision with negative margins?
An abstract presented at the 2017 ASTRO from MD Anderson Cancer Center by Andraos and colleagues (last author Dabaja) addressed this question in a retrospective analysis. Of the 39 patients who underwent complete resection of their nodal low grade FL, "those treated with adjuvant therapy experienced...
Would you treat bilateral synchronous breast cancers in prone position?
I have done this one time in past and fused two the CT scans to ensure that based on anatomy there is significant gap between two fields
In a patient who requires prostate cytoreduction prior to EBRT or brachytherapy, do you include a 5-alpha reductase inhibitor in your ADT regimen?
This is a great question. Although 5-aplha reductase inhibitors do shrink the prostate, there is little data reporting on its use prior to RT. Jethwa et al (J of Contem Brachytherapy 2016 Oct; 8(5): 371–378.) evaluated factors that impacted decrease in prostate volume and the initial prostate volu...
Would you recommend adjuvant chemoradiation for T1N0 gastric adenocarcinoma status post R0 resection but no D2 lymph node dissection?
I would not recommend adjuvant chemoradiation for a patient with an R0 resection for a T1N0 gastric adenocarcinoma even though a D2 dissection was not performed. If the patient had high risk factors, adjuvant chemotherapy may be appropriate in view of distant metastasis rates of ~ 30% with T1-2N0 le...
Would you offer RT to a large infiltrative renal metastasis in a patient with minimal other systemic disease?
With modern treatment delivery techniques, there really are no longer any regions in the body in which a potentially therapeutic dose of radiation cannot be delivered, and durable local control can be achieved in locations where this was not possible in the past. Nevertheless, as the question implie...
Is treating high-risk prostate cancer with trimodality therapy safe for a patient who remains on anti-PD1 therapy for metastatic melanoma?
More important question is do we need to treat patient with triple modality for high risk disease if they have metastatic melanoma as outcome would be dictated by metastatic disease
What is your standard dose for total skin irradiation in a mycosis fungoides patient?
Our standard has been to do the low-dose 12 Gy TSE regimen as it still has good overall response rates with low toxicity.https://www.ncbi.nlm.nih.gov/pubmed/25476993https://www.ncbi.nlm.nih.gov/pubmed/28843374I asked @Dr. First Last to weigh in on this and he agrees that 12 Gy is the standard.
Do you do recommend further mediastinal staging for patients with SCLC or inoperable NSCLC with N1 disease on PET?
I would usually request an EBUS. PET is really outstanding for staging of all lung cancer, but sensitivities in the 90+%, but it will occasionally miss the small nodes of the mediastinum. In SCLC, with a N1 node "with high SUV" the pretest probability of having an N2 node is quite high, so it would ...