Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer upfront radiation for a large painful keloid of the chest that has arisen from an irritated pyoderma gangrenosum lesion?
Radiation therapy is actually used (rarely) for pyoderma gangrenosum that has been unresponsive to medical management via immunosuppression [1]. Single fraction doses of 400 to 800 cGy have been used with slow regression of the lesions. In the case report cited, the lesion started fading after 3 mon...
How do you treat anal adenocarcinoma?
First of all you have to define what you are dealing with. Adenocarcinoma of the anal canal is a rare condition arising from anal glandular tissue. There is no IHC marker or definitive histologic finding that can differentiate it from rectal cancer with extension into the anal canal. The suggestive ...
Does the presence of perineural invasion in early-stage breast cancer post-lumpectomy affect the decision regarding partial breast vs whole breast radiation?
I have not used PNI as a risk factor to change local treatment options after BCS.
What is your preferred treatment for patients with painful gynecomastia on anti-androgen therapy for prostate cancer?
Gynecomastia can be a significant morbidity affecting the quality of life in patients on androgen deprivation therapy, especially in patients who receive bicalutamide as monotherapy or at higher doses such as 150 mg a day. In patients who are younger and/or who may spend time in public without their...
Are you incorporating TTFields into treatment protocols for locally advanced pancreatic cancer based on the PANOVA-3 study?
Most medical and radiation oncologists I have spoken to believe that TTFields offer benefit based on the PANOVA-3 trial and support routine use once it is FDA-approved. One of the outstanding questions relates to the use of definitive radiation therapy, which was not included in either arm, but is a...
What is your approach to uterine perforation during the time of brachytherapy implant for cervical cancer?
First off, I think uterine perforations occur a lot more frequently and easily than we previously accounted for. I learned how to perform brachytherapy using purely orthogonal X-rays, with dosing and dwell position times based on measured distances from the applicators, and all of the focus was plac...
Do you taper memantine after completion of 24 weeks of therapy?
Tapering is recommended when discontinuing some medications used in the management of dementia such as cholinesterase inhibitors. There are anecdotal cases of “discontinuation syndrome” after abrupt cessation of memantine in patients with dementia. However, this alone does not prove that a slow tape...
In light of the SHAPE trial results, how would you manage a patient with an incidentally diagnosed FIGO IA1 cervical cancer after simple extrafascial hysterectomy/BSO?
Without question, I would recommend that this patient receive pelvic RT and probably cuff brachytherapy as well. The SHAPE trial (NCT01658930) enrolled "low risk" patients, but they allowed LVSI patients into the trial, even though this is a high risk feature for local recurrence. There were approxi...
How well does a negative non-contrast MRI of the brain exclude metastasis in a patient with squamous cell carcinoma of the lung?
I don't think the question has enough information to give a good answer. For example, if it was a T3, N2 NSCLC, or a small cell, then "yes" I'd repeat the MRI with contrast. On the other hand, if it was a T1, N0 NSCLC, then "no", I wouldn't. In other words, if I thought there was a real risk of havi...
How would you approach adjuvant therapy for a fully resected vulvar carcinoma with a single positive lymph node?
There is not a simple answer to this question. In most cases, omitting adjuvant therapy is appropriate, but in certain cases, adjuvant radiation therapy + chemotherapy is advised, even in the presence of only a single positive lymph node. It has been over 30 years since Homesley and co-workers’ 1986...