Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you ever include the proximal seminal vesicles in your prostate SBRT volume?
I tend to include the proximal SVs for my intermediate risk prostate cancer patients getting SBRT. I usually use 8 Gy x5 for the prostate and 5 Gy x5 for the proximal SVs. I use the regimen from a colleague at UCLA and it seems well tolerated.
Given the improved ability to spare heart, kidney and liver, should IMRT be the standard of care for gastric MALT lymphoma (despite the low dose needed to effectively treat these patients)?
Gastric MALT lymphoma is a tantalizing disease to utilize IMRT. The target is typically irregularly shaped and surrounded by critical normal structures, including the heart, liver, and kidneys. The standard dose for gastric MALT lymphoma is 30 Gy. Thus, one needs to be mindful of dose to all of thes...
How do you approach post-prostatectomy pelvic lymph node only recurrence found on advanced imaging in a patient with a low PSA (~0.5)?
A lot will depend on the history of the patient. What were the initial parameters at the time of diagnosis (stage, initial PSA, Gleason score)? Were there positive margins at the time of surgery? How long of an interval before the time of recurrence? How was the "lymph node only" recurrence detected...
Is it reasonable to delay radiation therapy following surgical decompression for a patient with spinal cord compression if systemic therapy must be started as soon as possible?
I think it's unwise to delay RT for the usual solid tumor. 1) Surgical decompression seldom removes much tumor. 2) Most of these pts have already received significant chemo decreasing the chances of a meaningful response. 3) A rapid hypofractionated course of RT can usually be given resulting in onl...
What is the role of adjuvant radiation for gastric cancer found to be locally advanced after up-front surgery in the setting of <D2 but R0 resection?
I think one has to be very careful making blanket statements regarding management of the type of tumor described. The only real data supporting the standard use of RT in virtually all of these patients was the Macdonald trial from a couple of decades ago (and the patients were often treated three de...
Do you utilize daily enemas for patients undergoing prostate SBRT?
No. I'm not aware of strong evidence that daily enemas improve outcomes, and prefer to minimize the burden of treatment on patients unless we have a solid reason to think we are helping them. Most patients do well without enemas. However, I know enemas were recommended (not required) on PACE-A. I'm ...
Would you offer SBRT/hypofractionation for stage I NSCLC with positive margins after resection?
I agree that it feels a bit disingenuous, in an era where we can provide precision delivery to areas of the lung with high control rates and low toxicitity, to offer standard PORT over 5-6 weeks.However, I think the first question is not how to delivery RT, but whether to deliver it?The most relevan...
Do you treat bulky pelvic/retroperitoneal lymph nodes for prostate cancer to palliate lower extremity lymphedema?
Yes usually would use 35-40 Gy at 2.5 Gy per fraction
What factors do you take into account when deciding to offer SpaceOAR to patients with prostate cancer planning to undergo radiation therapy?
A shared decision-making opportunity. It has been interesting to see the pendulum of physician opinion swing back and forth a bit on this issue. [For those unfamiliar with the topic, in addition to reading the initial RCT results, it is worthwhile to read the later Lancet commentary: Hall et al., P...
Based on the results of CALGB 80803, would you consider induction and/or concurrent FOLFOX in neoadjuvant treatment of esophageal adenocarcinoma?
Great question. The CROSS regimen has been our standard for resectable GE junction and esophagus adenocarcinomas, but the data from the CALGB 80803 study are compelling.For some patients with questionable disease resectability, usually due to extensive nodal involvement, we have been giving “inducti...