Gastrointestinal Cancers   

Would chemoRT be preferred over surgery if there is LVI or PNI?

Does histology (radioresistant or radiosensitive) play into this decision?

Would portal hypertensive gastropathy or colopathy sway you away from using it?

And if delayed, should chemotherapy be started?

From NCCN (Rectal MS-33): SBRT is a reasonable option for patients who cannot be resected or ablated. What is the role of SBRT versus microwave ablat...

Or offer resection followed by adjuvant therapy? 

Is liquid biopsy helpful? Would you treat if this shows somatic mutation?

Will the results of the recently published randomized comparison of proton beam therapy (PBT) vs. transarterial chemoembolization (TACE) change the wa...

How do you sequence systemic treatment options for in patients with Child's Pugh B (or greater) in context of IMbrave150 and HIMALAYA? When do you in...

If the patient is outpatient and coming into clinic each day, at what point would you initiate a C. diff workup?

Have you noted significant diarrhea until the ileostomy is reversed?

Are there any medications that you can prescribe? Diet changes? Does this typically resolve on its own after time?

Is there a specific brand or formulation you prefer? The literature supporting the use of probiotics does not standardize the type or dose of probiot...

The patient already received PLADO+sorafenib, Y90, and Atezolizumab/Bevacizumab complicated by recurrent episodes of bleeding from esophageal varices....

Would you offer liver transplant in the setting of metastatic disease? 

Would you offer low dose or standard dose aspirin instead?

Would you try atezolizumab/bevacizumab or switch to a TKI?

Would you reduce dose, e.g. from 30 Gy in 10 fractions to 20 Gy in 5 fractions, or hyperfractionate, e.g. 1.5 Gy bid to 20-30 Gy?

For example in a patient with a history of PE?

i.e. EGD surveillance for varices?

ex. VEGFR2 expression, inflammatory signature, PDL1, etc.

Do you continue atezolizumab alone? Would you avoid anticoagulation?

In light of the SIRveNIB trial results and now IMbrave150, what is the role of intra-arterial therapy now?

Do you screen even asymptomatic patients?

In a patient with a large primary and a negative PET/CT for nodal disease, would you push for EUS for radiation planning? Or would this be an unnecess...

Do you recommend TACE, RFA, radioembolization, systemic therapy or SBRT?  What if the size is >5 cm?

Would your recommendations change if you were treating a GI primary (e.g. rectal or anal cancer) vs non-GI primary? 

If so, for what platelet count threshold and do you have a preference as to which agent?

Is there a "best" way to approach treatment of the viral infection i.e concurrently with therapy, prior to therapy, delayed or post therapy? Does this...

Do you have any preferred dose fractionation schedules? What kind of margins do you use?

Arterial events have clear instructions to permanently discontinue on the FDA label.  Especially in HCC without many other treatment options, giv...

Are there any indications to choose one over the other?