Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In what situation would you obtain an MRI before adjuvant or salvage RT to the prostate bed?
In my response, I will assume that the your treatment planning is CT based, as would be the case in most centers, including mine. In the adjuvant setting, I do not get MRIs, since by definition the PSA is undetectable and I do not feel that an MRI will give you useful information beyond what you wou...
Do you have a size criteria when treating lung oligometastases with SBRT?
A lesion 3-5 mm is difficult to characterize on PET, low yield for a biopsy, and non-specific, even if it developed in interval scans. Multiple 3-5 mm lesions could also be from an infectious/inflammatory condition. If the lesions are likely from cancer (i.e. new lesions with rising tumor markers, o...
Do you offer LDRT for psoriatic arthritis, rheumatoid arthritis, or polymyalgia rheumatica or fibromyalgia?
I have treated for RA and PA. I have not had any referrals for PMR or fibromyalgia. I have not considered for fibromyalgia, as I don't understand the condition well. For RA/PA, in many cases, they have not had any relief from medications, therapy, NSAIDs, and relying on opioids and other, at times, ...
Is there any benefit to the use of low dose radiation in patients with osteoarthritis who have already undergone joint replacement?
I've treated a lot of patients with LDRT for OA, but not many with joint replacements. The ones that still have pain after a joint replacement - I have told them that mechanistically it does not make a whole lot of sense to treat - I don't imagine it will have that same anti-inflammatory effect, as ...
Do you continue androgen receptor pathway inhibitors in patients receiving Lu177-PSMA for metastatic prostate cancer?
Yes, ARPIs can be continued during treatment. Just over half the patients on the VISION trial remained on enzalutamide or abiraterone. Outside of the ENZA-p trial (Phase IIR), there is no good evidence for or against the use of concurrent ARPI to my knowledge, although there really should not be syn...
Given the secondary analysis of RTOG 0617, should IMRT be considered standard of care in locally advanced non-small cell lung cancer?
The secondary analysis of RTOG 0617 (Chun et al. JCO.2016) supports the notion that IMRT should be the standard of care for the treatment of locally advanced non-small cell lung cancer (NSCLC). This study (0617) compared chemotherapy +either 60 Gy or 74 Gy of conventionally fractionated RT. The seco...
How do you approach adjuvant therapy of serous intraepithelial carcinoma of the endometrium?
I would favor no additional treatment as the risk of recurrence is low and no proven benefit of adjuvant RT.
When treating stage IVB cervical cancer with both systemic chemotherapy and local pelvic radiation therapy, do you incorporate the use of bevacizumab as in GOG 240?
I generally favor starting with multi-agent systemic therapy (Carbo/Taxol/Avastin +/- Pembro) upfront to confirm that the patient is going to respond appropriately and not blossom with metastatic disease prior to making a decision of radiating the pelvis in oligometastatic cervical cancer, similar t...
Is there an SIB boost regimen for a dominant prostate lesion for 60 Gy/20 fx to the whole prostate?
There are no phase III data providing guidance on the "isotoxic" boost dose for a 20-fraction, hypofractionated prostate treatment similar to the experimental arm in FLAME (Kerkmeijer et al., PMID 33471548), but there are two prospective studies of which I am aware, DELINEATE and ARO2020-01, which d...
Would you treat someone following FLAME protocol for prostate cancer without fiducials if using daily CBCT?
The underlying concept within this very practical question is how we rely on on-board imaging for target localization. In my practice, in which I have high confidence in my GTV contouring accuracy and daily setup, I would feel very comfortable using CBCT instead of fiducials. My ideal process includ...