Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you expect the 2023 FIGO staging for endometrial cancer to become adopted clinically in the US?
Agree with the previous comment. Current adjuvant RT for stage I and II are based on mainly histopathological classification (PORTEC-I/II). However, the recent publication of PORTEC-4a (Horeweg et al., PMID 37487144) for stage I/II showed molecular classification predicts response for stage I/II. Mo...
How should molecular studies, in particular the presence of POLE or p53 mutations, be incorporated into the decision to treat an "intermediate risk" endometrial cancer patient with adjuvant therapy after hysterectomy?
PORTEC, ESMO, and SGO guidelines support molecular characterization of endometrial cancer based on the TCGA/ProMisE classifications. p53 is a predictive biomarker for response and prognosis while POLE is prognostic. Based on the most recent SGO clinical practice statement, these can be used to escal...
What is your typical approach for soft tissue sarcomas of the buttock?
It is worthwhile remembering that the entire paradigm of conservative/limb-sparing surgery rather than radical surgery/amputation for extremity STS (as defined all the way back to Rosenberg et al., PMID 7114936 and Yang et al., PMID 9440743) *presupposes* that patients also receive RT. Therefore, fo...
What is your palliative radiation approach to larger volume locoregional head and neck SCC recurrences?
If there was no prior RT, for palliation-30 Gy/10 fractions or 20 Gy/2 fractions with 1 week interfraction interval. If there was prior RT, for palliation-30 Gy/12 fractions For reRT with curative intent-64.8 Gy at 1.2 Gy per twice daily fraction. ReRT the recurrence or second primary site with marg...
How do you treat locally advanced GE junction adenocarcinoma extending to the esophagus and cardia when the Siewert Type is indistinguishable between 2 and 3?
There is no "correct" answer to this question as both relevant trials seemed to have improved outcomes with this type of disease, so either approach would be acceptable. However, I think one has to keep in mind that there are (at least) 2 factors that would drive a decision. One is biology and the ...
At what PSA do you initiate ADT for a biochemical recurrence after prostate radiotherapy (adjuvant, salvage, or definitive)?
Great question, and one that highlights the variability in practice and philosophy that often emerges to fill the void when hard data and concrete guidelines are lacking. I find that the PSA doubling-time (DT) often tracks with patient and provider anxiety levels; a rapid DT (<8-10 mos or so) in an ...
How do you decide the right time to transition to hospice?
Talking about hospice is one of the hardest jobs we have. It's hard because we don't like doing it, because we often don't know how to do it well, and because we angst about doing it too early or too late. It's an important thing to think about. I actually think perhaps the most important factor in ...
How do you treat dermal metastases in the setting of prior breast irradiation?
There is no fixed approach. Based on effect and volume of prior RT, interval since last treatment, extent of dermal mets with or without surgical excision, and intent of care. One can do conventional fraction RT with or without hyperthermia, based on availability and gross or microscopic disease.
What are your top takeaways in Breast Cancer from ASTRO 2024?
There were a number of important presentations on breast cancer at the ASTRO 2024 meeting. The three randomized trial discussed below stood out.1. Abstract 1: Poppe MM, et al.: A randomized trial of hypofractionated post-mastectomy radiation therapy (PMRT) in women with breast reconstruction (RT CHA...
Does a genetic predisposition to cancer affect your recommendations regarding breast conservation and radiation?
The question posed makes the assumption that radiation should be avoided in ATM, BRCA, and p53, and asks about other genes. I would begin by stating that radiation should not necessarily be avoided in the vast majority of patients with genetic variants or mutations, even those referred to in the que...