Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach an out of field intracranial recurrence for a GBM?
Any patient with recurrent GBM should have multidisciplinary evaluation for indivdualized clinical decision. For patients with out of field recurrence, I would still consider clinical trials as the first option. Off trial, multiple factors should be taken into consideration, including, age, KPS, ne...
When treating keloids with electrons post-operatively, what margin do you use when making your electron field cut out?
Usually about 1 cm around the scar on each side to account for penumbra which is 10% of energy of electron (6 mm for 6 mev electron) and small set up uncertainty.
If an anatomical defect forms due to rapid disease response from pelvic radiation for large gynecological tumors, is it safe to proceed with a further radiotherapy boost?
I would proceed with brachytherapy as planned. For a fistula, if symptomatic, would consider diversion - bilateral nephrostomy or diversion colostomy as needed. Brachytherapy would treat the involved bladder or rectal wall to a therapeutic dose without any needles in the tissue, thereby avoiding any...
Given POP-RT trial, do you cover elective nodes in high risk prostate cancer?
Ah, to treat nodes or not for prostate cancer -- an area that everyone loves to debate. The recent, fascinating POP-RT trial does shed some important light on this topic, but it's important to keep the trial's patient population in mind when deciding whom to apply it to. Also, the trial is not witho...
Why is there a benefit of ADT for high risk prostate cancer treated with radiation, yet no large trials describing benefit of adjuvant ADT after radical prostatectomy?
From a high level, the magnitude of the benefit of ADT with radiation seems proportional to the aggressiveness of the disease (i.e. low risk has no significant benefit, int risk weighs risk features and cardiac health, and high risk the benefit of ADT can trump cardiac risk). In that context, we hav...
What CTV margin do you use for IDH-mutant WHO grade 3 or 4 astrocytoma?
IDH-mutant (IDHm) WHO grade 3 or 4 astrocytomas carry a better prognosis than their IDH-wild type (IDH-wt) counterparts. These patients tend to live significantly longer than the IDH-wt. Current NRG consensus guidelines call for a 2 cm expansion over the GTV1 (T2/Flair) and GTV2 (cavity and any resi...
If a stage I laryngeal cancer completely responds to FU-based chemotherapy (given for another malignancy) would you consider observation?
We expect a 60-80% response rate with induction chemo data, with 20% having a complete response. That doesn’t preclude local treatment but predicts for better outcome.
Is there evidence supporting the role of SBRT in the management of oligometastatic stage IV NSCLC?
Yes. I would look at a great trial from Wake Forest, looking at consolidative radiotherapy after 3-6 cycles of platinum-based chemotherapy, followed by observation, so chemotherapy, then radiotherapy, then observation (no maintenance chemotherapy). The trial occurred from 2010 to 2015. This single-a...
Would you recommend large-field radiation therapy to treat SCC of the skin with field cancerization (e.g., entire forearm, scalp) in elderly patients with CLL/immune compromise who have had mixed responses to cemiplimab?
Yes, retrospective data from Australia support large fields using VMAT at a median dose of 47.9 Gy in an average of 23.9 fractions with treatment breaks as needed and using a custom bolus. The photos in the article help clarify what is meant by 'field cancerization.' This phenomenon is termed extens...
Is there any way to safely treat patients with mCRPC with 177-Lu PSMA who are on hemodialysis?
For the most part, no. Not unless you're a big academic medical center with a robust multidisciplinary team willing to tackle the significant logistical challenges associated with this scenario.I'm aware of no literature in this scenario specifically for Pluvicto, but we can look at the radiopharmac...