Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend a washout period for a patient receiving intrathecal chemotherapies prior to/after receiving intracranial SRS?
There are not a whole lot of clinical data. A couple of general points: 1) some chemotherapy agents, especially methotrexate, are known to increase CNS toxicity of radiation (especially whole brain RT) when used concurrently; 2) intrathecally administrated chemotherapy nonetheless has generally limi...
Do you utilize tumor treating fields in patients with anaplastic pleomorphic xanthoastrocytoma (PXA) III?
I would, but I haven't actually had the opportunity. With more information appearing that TTF is effective in brain metastases, mesothelioma, and pancreatic cancer, why wouldn't you use it if you didn't have a better option? The only real risk is financial.
How would you approach surveillance imaging for men with early-stage, hormone receptor-positive breast cancer after unilateral mastectomy?
As always, appreciate others' input. If you're referring to systemic imaging, I do not obtain surveillance systemic imaging as part of surveillance for any patient with early-stage hormone-positive breast cancer (male or female) unless there are symptoms or initial labs that suggest possible metasta...
Is it ever acceptable for high risk prostate cancer patients to be treated with upfront radical prostatectomy?
This is an excellent and timely question. There is definitely an increasing trend of patients with high-risk prostate cancer (PCa) receiving upfront radical prostatectomy (RP). Some of this is spurred by a recent, high-profile meta-analysis (https://www.ncbi.nlm.nih.gov/pubmed/26700655), which poole...
How do you apply brain metastasis velocity in the clinic?
Brain metastasis velocity is calculated by the number of new brain metastases since initial SRS, divided by the time in years of developing those brain metastases. Less than 4 per year is considered low, 4 to 13 per year is considered intermediate, and more than 13 brain mets in a year is considered...
When a patient with pancreatic cancer received neoadjuvant chemo + chemo-RT, how do you manage an in-field, post operative positive margin?
The data from MD Anderson indicates that patients have a similar survival duration when they have an R1 resection after chemoradiation as when they have an R0 resection, and longer than expected with a positive margin. The Mayo Clinic also has data in rectal cancer where there may be an increased ri...
Do you prescribe respiratory muscle training (RMT) devices to patients with dysphagia?
We encounter dysphagia frequently in our patients with Parkinson's disease and other movement disorders. If there are any concerns about swallowing or aspiration, my first step is to refer to Speech Therapy for evaluation, and I defer to their expertise for specific treatments from there. That said,...
What pathological factors do you use to consider treatment of the axillary level I/II after an axillary dissection?
We examined the risk of axillary failure in relation to the number of positive nodes AND the number of nodes removed by axillary dissection for patients undergoing mastectomy without PMRT in ECOG patients treated with chemotherapy in trials conducted from 1972-1987 (Recht et al., PMID 10561205). Wit...
How do you manage fatigue in women receiving chemotherapy/hormonal/radiation therapy for breast cancer?
Managing fatigue is challenging for patients undergoing cancer therapy. One of the best ways to increase energy is to exercise. It is a bit of a catch 22, but if you explain to patients they can start out with small goals and there symptoms will improve that can help. A very important contributor to...
What are your target volumes and dose for recurrent atypical meningiomas that have been initially treated with definitive surgery alone?
These questions get to the bottom of several important issues facing patients with WHO grade II meningioma and physicians treating them. Permit me to approach these inquiries as if writing a Scientific American article, answers first, then some abbreviated supporting documentation. Regarding treatme...