Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a subcutaneous metastatic atypical carcinoid tumor?
If it is solitary, one can excise it also for local control.
In a patient with an R1 resection of a chordoma who has declined proton therapy, what alternative radiation modality would you recommend?
Chordomas are aggressive and locally invasive tumors that commonly arise in the sacrum, skull base, or rarely the mobile spine. Resection is considered the first-line treatment; however, wide margins are difficult to achieve without significant morbidity. By nature of their site of origin near or ad...
Would you offer PMRT to a young patient with a remote history of mantle/lung RT for Hodgkins lymphoma and a left cT0N1 triple positive breast cancer with a complete response after neoadjuvant chemotherapy?
I would favor adjuvant RT in this situation. Given up front bulky and multiple nodes, even though she had pathologic complete response. I would cover chest wall, axilla, and SCV fossa and consider IMNs based on cardiac and pulmonary doses.
Would you consider delaying tarlatamab initiation in a patient with ES SCLC who recently completed RT for CNS disease, given the concern for immune effector cell-associated neurotoxicity syndrome (ICANS)?
I would not delay beyond what we already do for other systemic treatments. We tend to wait at least a week or more after whole brain RT and systemic therapy of any nature. I do not think this is any different.
Would you consider upfront immunotherapy in a patient with MSI strongly positive locally advanced adenocarcinoma of the anus versus standard of care?
Great question. For anal and rectal cancers, histology generally supersedes location in determining treatment paradigm, so an anal adenocarcinoma would be treated like a rectal adenocarcinoma (you might consider anal canal involvement T4 staging).Standards of care for MSI-H locally advanced rectal a...
Would you add whole-pelvis radiation as MDT (metastasis-directed therapy) in a patient with 1 pelvic node and 2 osseous metastatic sites for castrate-resistant prostate cancer?
This patient would not fit the PEACE V-STORM eligibility criteria, since the trial excluded patients with distant metastases and did not include patients who were castrate resistant, so I do not think you can extrapolate the results to this patient. One could argue that what you propose to do (SBRT ...
When planning spine SBRT, do you use volume dose limits to the spinal cord PRV, such as D0.35cc, in addition to maximum point dose?
An excellent recent paper from the MSK group on 3-fraction spinal SBRT (minimum dose of 27 Gy to PTV) was published last year, examining dosimetric predictors of radiation myelopathy. Of note, spinal cord delineation in this study was done using myelogram in 85% of cases, with 15% of cases utilizing...
How do you manage a seminal vesicle recurrence after prostate brachytherapy?
Finding more of these in the PSMA era. Have managed a few patients with SBRT +/- ADT adjusting dose based on overlapping OAR if needed.
How would you approach management of a large, fungating squamous cell carcinoma of the auricle if surgical management is not desired by the patient?
For a tumor this size and with cartilage invasion, I would recommend starting with induction cemiplimab to best response (generally 4-6 cycles), followed by consolidative RT, generally electrons. Prior to starting the immunotherapy, I would stage the neck with a contrast CT scan, as tumors of this s...
Are there any online or publicly available pelvic floor physical therapy resources you regularly use or offer to patients?
PFPT is a great adjunct to many treatment regimens for pelvic conditions, such as urge or stress incontinence, dyspareunia, and pelvic pain. While supervised PFPT is outstanding, many women cannot maintain regular follow-up sessions, especially if they have to travel. I direct my patients to YouTube...