Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the current role for genetic profile testing (e.g. DecisionDx-SCC) in the treatment paradigm for cutaneous malignancies?
This is a very cool test that has a lot of potential to help us make decisions in practice (full disclosure, I advise Castle and get research support from them, but am not directly compensated by them). The data published thus far shows that it is prognostic to predict nodal or distant mets. However...
Will you extrapolate EORTC 1333/PEACE-3 (enzalutamide + Rad223) to any other ARPIs for mCRPC?
PEACE-3 was a cooperative group study of radium-223 plus enzalutamide versus enzalutamide alone in men with mCRPC. There was a significant improvement in OS (38 months vs 32 months). Most patients in the trial were previously treated with ADT monotherapy instead of intensified therapy (i.e., ADT + A...
What dose constraints do you use for RCC/Kidney SBRT?
As is often the case, there is no single answer to this question, and the ALARA principle should always be kept in mind. A good starting place to determine your OAR constraints for a given case is to consider the clinical context. Ultimately, in deciding on allowable OAR constraints, one has to cons...
Do you get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...
What is your response to the question, "Is this terminal?"
Thanks for this question, it's really important. This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life. Let's talk about them in sequence. 1). At diagnosis: When a person is first diagnosed, this question is part of "getti...
How does neoadjuvant chemo-immunotherapy impact your decision on hypofractionation/dose fractionation for locally advanced NSCLC, now getting RT alone?
If a patient has already received 3-4 months of a platinum-doublet chemotherapy during the chemo-immunotherapy phase, then it's always my preference to omit further chemotherapy and recommend RT alone. The rationale for this recommendation is that we don't administer additional chemotherapy to patie...
Do the results and approval based on ADAURA trial suggest a role for adjuvant osimertinib in patients with stage IIIB-C, EGFR mutant patients treated with concurrent chemoradiation?
ADAURA trial was not designed to address this issue. But that being said, we need to remember few things before considering "maintenance durvalumab" in patients with EGFR-mutant lung cancer, following chemo-radiation: 1. EGFR-mutant NSCLC patients may not derive any clinical benefit from single-agen...
How long can you delay the start of radiation in a patient who has received adjuvant chemotherapy after lumpectomy/mastectomy?
I generally start radiation between 3 and 8 weeks following the last dose of chemotherapy. Since most protocol guidelines specify radiation should start within 12 weeks of the last day of chemo is within the last surgical procedure, I use that as an outside window I am comfortable with for the most ...
When treating prostate cancer with moderate hypo-fractionation, what urethral dose constraints do you consider when boosting the dominate intraprostatic lesion?
As Dr. @Dr. First Last mentions, the FLAME protocol did not utilize a urethral constraint; however, in a post hoc analysis, they did suggest a constraint of D0.01cc ≤ 80 Gy in 35 fractions (Groen et al., PMID 34968470). It is hard to know how to apply this given the uncertainty regarding the appropr...
How are you integrating Prostox into your practice for prostate patients deciding between SBRT and hypofractionation?
Curious how people are using this test?