Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer postoperative radiation for adrenocortical carcinoma?
I just answered a similar question asking about ACC s/p resection with a positive margin, but the same principles apply here: Adrenocortical carcinoma is a very rare entity, and it is associated with a poor prognosis. I have only treated a few. Despite aggressive resection, there is a high rate of l...
Do you recommend adjuvant XRT for adrenal cortical carcinoma s/p resection with a positive margin?
Adrenocortical carcinoma is a very rare entity, and it is associated with a poor prognosis. I have only treated a few. Despite aggressive resection, there is a high rate of locoregional failure. The data regarding adjuvant radiation after surgery are very limited, mostly small retrospective studies....
When do you initiate vaginal cuff brachytherapy treatment after hysterectomy for early stage endometrial cancer?
We usually start vaginal cuff treatment 5-6 weeks after hysterectomy. If adequately healed, may start at 4 weeks but not before. Rarely more than 8 weeks. For patients receiving vaginal cuff treatment plus chemotherapy, we still give cuff treatment within 6 weeks. There is no reason to delay because...
What salvage EBRT dose would you recommend for radiation-naive patients with Hodgkin's Lymphoma who are refractory to chemotherapy and immunotherapy and decline to undergo transplant?
This is likely a palliative scenario, thus, I would try to limit toxicity and time spent on treatment. 30-36/3 appears reasonable, in my opinion.
What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?
Dexamethasone is one of the most frequently prescribed medications in neuro-oncology clinics. Dexamethasone is often favored over other corticosteroids owing to its lower mineralocorticoid effects and high potency as well as essentially 1:1 oral to IV ratio meaning that we use similar IV and oral do...
When treating endometrial cancer patients with a combination of chemotherapy and vaginal cuff brachytherapy, when do you deliver cuff brachy?
I prefer, most of the time, between the cycles of chemotherapy (1 to 3) based on logistics.
When treating a patient with classic early stage diffuse large B-cell lymphoma (Stage I/II), when is it appropriate for patients to receive 3 versus 6 cycles of R-CHOP chemotherapy when the treatment is followed by ISRT?
The SWOG 8736 study included patients with stage I (bulky or non-bulky) and nonbulky stage II aggressive non-Hodgkin lymphomas (mostly DLBCL). Bulky was defined as a mediastinal mass >1/3 maximal chest diameter or any mass > 10 cm. Patients were randomized to 8 cycles of CHOP or 3 cycles of CHOP + R...
What would your approach be in a man currently on treatment for high-risk prostate cancer with ADT who does not have castrate levels of testosterone?
Yes, I would try alternative agents. If using Lupron, consider relugolix, degarelix, high-dose bicalutamide, or even adding an ARSI.
What fractionation would you offer to a young pre-menopausal woman with early stage ER+/HER2- breast cancer who received adjuvant chemotherapy and is highly interested in maximizing breast cosmesis?
40 Gy in 15 fractions with focus on dose homogeneity aiming for V105 < 5%.
Given the results of LU002 presented at ASCO 2024, are there situations and/or patient subgroups who still derive benefit from local consolidative therapy for oligometastatic NSCLC?
This is a tricky trial to interpret. They allowed a mixture of "stage I" primaries with oligomets and "stage III" locoregional disease with oligomets. The former got SBRT to the primary and the latter got 45 Gy/15 fx to primary and involved LN. There is a huge difference in the "ablativeness" of tho...