Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Is it necessary to treat the entire larynx with intermediate or elective dose in a T1/T2 squamous cell carcinoma of the supraglottic or subglottic larynx?
It would be hard to miss it without missing your target. Additionally, you have level 6 nodes with the subglottis and levels 2-4 with the supraglottis. Not a great idea. To clarify, don’t try to spare the glottis.
Is it feasible to treat central liver tumors +/- portal vein thrombus with SBRT while minding central hepatobiliary tract constraints?
Remember that biliary strictures frequently cause death in these patients because stents don't always drain after these high doses of radiation. I have personally never caused a biliary stricture. The regimens that I am using with an SBRT technique are below the threshold for biliary stricture and r...
When is it appropriate to recommend SBRT directed to sites of oligometastasis (ex, single adrenal met) for a patient with extensive stage small cell s/p chemo and PCI?
May I play devil's advocate for one moment? I don't wholly disagree with @Dr. First Last btw, fwiw.1) Some people with SCLC can be cured. It appears that the application of a local therapy in limited stage SCLC increases the chance for long-term DFS (aka "a cure"). Five-year survival was doubled fro...
Have the results of the OPRA trial influenced your decision to recommend long course chemoradiation vs short course radiation therapy for patients receiving TNT who intend to undergo surgery?
The TME-free survival rate in the OPRA trial has solidified chemoradiation followed by consolidative chemotherapy as a standard in our practice. However, since the principal investigator is at our institution, it just meant that we continued doing what we were doing. It is important to realize that ...