Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How does a negative PSMA PET change your management when completing salvage radiation for prostate cancer?
It's important to remember that if patients are being referred early for salvage RT, most of them will have negative PSMA PET/CTs (< 50% are positive if the PSA is < 0.5). So, in these cases, you are relying on the usual factors to decide on treatment fields, dosing, and the use of ADT, including ot...
How do you contour proximal SV for definitive prostate EBRT?
Few people may know where the idea of the proximal seminal vesicle CTV came from. After the RTOG had completed it's 9406 phase II dose-escalation study with 3DCRT, we began the 0126 phase III trial of 70.2Gy vs 79.2Gy with 3DCRT. For the intermediate-risk patients, the predecessor 9406 study had a c...
Would you offer radiation therapy to a NF-1 patient with a painful and unresectable neurofibroma of the head and neck?
I assume this is a plexiform neurofibroma and its nerve related pain along the upper T or C-spine nerve roots?I would avoid radiotherapy if possible and instead work with your oncologist to evaluate whether the patient is a candidate for something like selumetinib if the lesion is progressive as the...
Is it safe to re-irradiate non-spine bone metastases with SBRT if they received previous SBRT?
This is a difficult question to answer. I would say "it depends." I would tread carefully with repeat SBRT for non-spine bone metastases in the following situations: 1. Mets that involve long bones/weight-bearing bones. Would ask ortho for an evaluation of the risk of fracture in weight-bearing bone...
Is there an age cut off below you would not treat a keloid with radiation post surgical excision?
While radiotherapy is considered an extremely useful modality in the treatment of recurrent keloids in the adult population, most would contend that the risks do not justify the application of adjuvant radiotherapy in the pediatric population (PMID: 10703484) for a benign condition when other modali...
How do you manage refractory radiation cystitis status post pelvic EBRT/BT?
Thankfully chronic radiation cystitis and specifically radiation-induced hemorrhagic cystitis is relatively rare (2-8%) [1]. However, it can be a chronic and debilitating complication after pelvic radiotherapy. In managing these patients, first, I make sure to rule out another cause of cystitis – in...
How do you approach treatment of a craniopharyngioma in an older adult patient?
There is a bimodal age distribution, with one peak in children between 5 and 14 years old and the second peak in adults between 50 and 75 years of age. Adamantinomatous (frequently with calcification) craniopharyngiomas are more common in children, while papillary (frequently lack calcification) cra...
How do you manage a T1N0 well differentiated anal margin squamous cell carcinoma with low-grade dysplasia at the surgical margin who has already undergone re-excision and is not eligible for further excision without an APR?
There is absolutely no role for the adjuvant treatment of carcinoma in situ or dysplasia in anal margin squamous cell carcinoma. The reasons for this are that 1) This is not cancer. The patient will live a long time. If you cause any long-term effects in a person who does not have cancer such as pai...
In patients with T1 anal squamous cell cancer status post local excision with a close margin, would you recommend close observation or adjuvant concurrent chemoradiation?
I would solicit the opinions of my colorectal surgery and GI colleagues to see if re-resection (with TAMIS, for example) is possible. If it is not, I would likely observe. If the margin was positive and not just close, I would do traditional chemoradiation.
How does a pathological CR to neoadjuvant chemotherapy influence your practice for the use of bolus with adjuvant PMRT patients without inflammatory breast cancer, but who would meet traditional risk factors for skin involvement?
I would favor a bolus for the first half of treatment.