Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When is it appropriate to recommend SBRT directed to sites of oligometastasis (ex, single adrenal met) for a patient with extensive stage small cell s/p chemo and PCI?
May I play devil's advocate for one moment? I don't wholly disagree with @Dr. First Last btw, fwiw.1) Some people with SCLC can be cured. It appears that the application of a local therapy in limited stage SCLC increases the chance for long-term DFS (aka "a cure"). Five-year survival was doubled fro...
Have the results of the OPRA trial influenced your decision to recommend long course chemoradiation vs short course radiation therapy for patients receiving TNT who intend to undergo surgery?
The TME-free survival rate in the OPRA trial has solidified chemoradiation followed by consolidative chemotherapy as a standard in our practice. However, since the principal investigator is at our institution, it just meant that we continued doing what we were doing. It is important to realize that ...
How do you approach prostate cancer patients who have hypertestosteronism on pre-treatment labs?
This is rare and full disclosure - I have not personally experienced this situation and this answer is based on discussion with colleagues. I suspect whatever the true incidence is, it is likely detected in only a fraction of patients as ADT is often initiated without drawing testosterone levels, an...
How do you avoid epilation in patients hoping to preserve their facial hair during radiotherapy?
Interesting question. I have not created an avoidance. It’s my experience that doses of about 50 Gy+ commonly cause permanent hair loss. It’s hard to avoid hair loss in areas where elective nodal or mucosal/skin coverage is needed. It’s certainly disappointing for some patients. In many scenarios of...
How would you treat a schwannoma of the breast with a positive margin that is not amenable to re-excision?
If it's pure schwannoma, it's benign pathology, and I would not do anything for microscopic residual disease.
How do you approach brain SRS for patients currently receiving Trastuzumab deruxtecan with progressive brain lesions?
Trastuzumab deruxtecan is an antibody drug conjugate targeting HER2 cells. This agent has recently been compared to a similar antibody drug conjugate T-DM1 (Kadcyla) and was found to improve disease progression and lower the risk of death for patients with relapsed HER2 metastatic breast cancer (Cor...
What are the indications for PMRT in an ER/PR(+) Her-2(-) patient with a complete pathologic response in the nodes after neoadjuvant chemo, but with residual disease in the breast?
This is an area where there is still a paucity of information. Hence, all guidelines need to be very tentative. I recommend PMRT for all patients having biopsy-proven axillary node involvement prior to chemotherapy, as I am concerned these are the patients at highest risk of local-regional failure. ...
Would you ever recommend testosterone replacement for men with incomplete T recovery after ADT for prostate cancer?
I have been hesitant to agree to supplemental testosterone after prostate cancer treatment, especially within the first few years. Prostate biopsies during that time often show atypical cells that are suspicious or adenocarcinoma with treatment effect. Androgens are pro-survival and the full effects...
When do you refer patients receiving CNS-directed radiotherapy to endocrinology?
In my practice, patients with pituitary tumors are followed by a pituitary endocrinologist. For all the other skull based tumors, I usually don’t refer patients to endocrinology unless a patient is found to have abnormalities with their pituitary function tests. We screen most patients with skull ba...
In what setting is PMRT indicated for T1-2N0 breast cancer?
In general, I do not offer PMRT to node negative patients with the exception of broadly positive margins. However, there is data to support the use of CW and RNI in the recently published EORTC 22922 trial in which more than 40% of patients were node negative (25% of patients were mastectomy patient...