Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In patients with unresectable, liver-limited neuroendocrine tumors (NETs), what clinical or radiographic criteria guide your decision to prioritize systemic therapy over locoregional approaches?
The first question is always if it is truly unresectable... What is considered unresectable by some might be considered resectable by others, so I always recommend getting an opinion from an HPB surgeon with substantial experience in treating patients with NETs (whether that is done in person or at ...
How do you manage neurocognitive decline associated with chemotherapy (i.e. chemo brain)?
I agree with @Dr. First Last's detailed response. Practically speaking, I would also add that it is important to listen and validate your patient's concerns and respond to their frustration and sense of loss. A diagnostic evaluation will not only help you and your patient discover or 'rule out' othe...
What resources/ancillary staff do you utilize for school re-entry after cancer treatment to decrease anxiety, improve self-confidence, and support emotional functioning?
Facilitating school re-entry for children and adolescents undergoing cancer treatment is an important component of comprehensive care. Maintaining engagement in school can help preserve a sense of normalcy and mitigate feelings of isolation and loneliness. However, the transition back to school may ...
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,...
Can a PSA bounce be seen shortly after SBRT to prostate cancer oligometastases while on androgen deprivation therapy?
I would not consider it a "bounce" if it happens shortly after treatment because the timing of a post-treatment bounce is later. If the PSA is higher than pre-treatment baseline soon after metastasis-directed SBRT, then you are likely observing one of two scenarios. First, the pre-treatment baseline...
How do you manage dry eye syndrome due to lacrimal or meiobian gland dysfunction after external beam radiotherapy?
I have also found autologous serum (AS) or platelet-rich plasma (PRP) eye drops/tears to be extremely useful (provided by an ophthalmologist). Dry eye can also be exacerbated by graft vs. host disease, which I have anecdotally seen worsened within radiation fields and is characterized by a lasting m...
Do you offer RT both to the prostate and synchronous oligometastases in de novo oligometastatic prostate cancer?
We do not yet have good evidence to tell us whether or when we should offer metastasis-directed therapy (MDT) for de novo oligometastatic prostate cancer. ORIOLE (like STOMP) was conducted in the recurrent setting. Those trials showed that MDT could delay progression and possibly allow a delay in th...
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
How are you modifying your current sarcoma-directed therapy in the setting of the COVID-19 pandemic?
Here are the guidelines at Fox Chase Cancer Center by Margaret von Mehren MD, @Dr. First Last , Jeffrey Farma MD, Sanjay Reddy MD, John Abraham, MD, and Stephanie Greco, MD I. Management of STS during COVID-19 Pandemic: During the current pandemic, care will need to be changed to allow for hospitals...
How do you approach rising PSA following radical prostatectomy and early salvage radiation therapy?
There are several factors that I will take into consideration, including the patient's overall health, the interval from treatment to relapse, the PSA doubling time (rather than a PSA threshold), whether or not they're castrate resistant and whether or not they now have overt metastatic disease. Pat...