Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In the setting of prior salvage radiation therapy for rising PSA post prostatectomy, can there be any role of additional radiation therapy for isolated local recurrence in the bladder neck/prostate bed?
I have not run into this scenario. If it is visible on imaging (ultrasound +/- CT or MRI) I would explore the possibility of HDR, 13.5 Gy x 2. Careful consideration would need to be given to the location of the recurrence and anatomy. Technically it may be challenging due to scar tissue and the limi...
How do you manage a cytology-negative pleural effusion that develops after lung RT?
I think most times you can just watch them as long as they are stable and not symptomatic. I see them not infrequently after RT, especially lung SBRT, and find they often find a size they feel comfortable with and don't change much over time. I wonder about their physiology... my impression is there...
Is it safe to deliver definitive radiation for a solid tumor malignancy (ie H&N) concurrently with maintenance lenalidomide/Revlimid for multiple myeloma?
The combination should be adequately tolerated, assuming that the patient is otherwise of good KPS at baseline without significant risk factors. The caveat here is that data on concurrent RT and novel thalidomide analogs (lenalidomide) is largely limited to retrospective reviews, singular case repor...
Do you base liver SBRT dose fractionation on size, volume, or proximity of normal tissue?
I think about this differently than most people do. My goal is to deliver an ablative dose (100 Gy BED) regardless of the proximity of organs at risk or the size of the tumor. The more common thing to do is to reduce the dose of radiation below an ablative dose to 40 or 30 Gy in 5 fractions. I'm not...
Would you treat an enlarging metastasis of the brainstem/upper cervical spinal cord with SRS in the setting of widespread disease and prior WBRT?
From what I understand, this is a patient with extensive-stage SCLC and widespread intracranial disease (>40 brain metastases), previously treated with WBRT (presumably 30 Gy in 10 fractions?), now presenting with a symptomatic (~2–3 cm) enlarging lesion at the brainstem/upper cervical spinal cord j...
How would you treat a patient with osteoarthritis of just one joint of the hand?
People do this in various ways - some people treat the joint with a large margin, others may treat the whole hand.I originally started by treating the affected joint, but pretty soon I after I switched and started treating the whole hand - pain is subjective and though it may appear localized, there...
What do you view as the optimal use and timing of cemiplimab in high risk CSCC?
Increasingly, neoadjuvant cemiplimab has become our preferred approach for many patients with resectable high-risk CSCC, and this is consistent with what several high-volume centers are now doing. The high pathologic response rates, durable recurrence-free survival in responders, and meaningful surg...
Is it acceptable to give weekly cisplatin for patients with locally advanced head and neck SCC undergoing chemoradiation?
@Dr. First Last just presented at the ASCO H&N highlights session that weekly cisplatin 40mg/m2 is now considered a standard of care, at least in the post-op high risk setting based on data by Dr. Kiyota et al. showing superior outcomes, likely due to higher cumulative cisplatin dose (>200mg/m2) com...
In light of the recent data indicating increased late grade 3 to 5 toxicities (LTOX3) after hypofractionated salvage radiation therapy, will you continue to offer these regimes to patients?
Prior Literature: Prior non-randomized studies seem to suggest excess toxicity with hypofractionated PORT (e.g., Cozzarini et al., PMID 24985964, Tandberg et al., PMID 29559284). In part for this reason, a phase III, randomized controlled non-inferiority trial, NRG-GU003, was conducted (Buyyounouski...
How would you treat a young man with a history of stage IA testicular pure seminoma s/p radical orchiectomy who has a solitary left inguinal lymph node recurrence and normal tumor markers?
Relapse in an inguinal node is somewhat unusual in testicular cancer unless there has been prior scrotal violation or surgery for maldescent. Trans-scrotal biopsy of the testis is usually an incorrect approach, as it can cause a different pattern of spread (to the inguinal nodes). Thus, I would not ...