Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose fractionation would you use on a large retroperitoneal recurrence of cervical cancer that is extending to previously treated 5040cGy pelvis?
Favor starting with chemotherapy, and planning RT based on response to chemo as volume and dose can be adjusted based on response.
What palliative regimen do you use for intra-pelvic recurrence of cervical cancer after definitive chemoRT with T&O brachytherapy?
Based on performance status, expected survival, the time elapsed from previous RT, and volume to treat, have used quad shot to 24-30 in 12 to 15 fraction or salvage HDR interstitial to EQ2 dose of 40 Gy or so.
What HDR dosing would you use in the neoadjuvant setting of endometrial cancer?
This is our experience: I use 5 Gy x 3 to 4 fractions based on response with EBRT with EQ2 dose of around 65 Gy.Vargo et al., 25218303Iheagwara et al., PMID 30802615
What is the role of uterine artery embolization (UAE) in patients with locally advanced cervical cancer with emergent bleeding that persists through vaginal packing?
With packing and starting urgent chemo RT, the need for embolization is very limited in our practice. That being said, data suggest if embolization is done, it doesn’t affect efficacy or complication risk of subsequent chemo RT.
How do you treat cervical cancer with an ovarian metastasis?
This is a data free zone but several papers report a very poor prognosis for these patients. For a limited ovarian met with pelvic localized disease, one may consider chemoradiation and add adjuvant chemotherapy (to follow) but these patients generally fail systemically. Hence, chemotherapy should b...
When using active surveillance for rising PSA after prostatectomy, at what level of PSA would you start ADT?
Given the EMBARK data (Freedland et al., PMID 37851874), I would typically treat with ADT + enzalutamide if the PSA level was between 2.0 and 5.0 ng/mL following maximal definitive local therapy (RP + adjuvant/salvage RT). This would apply only to patients with a PSADT of <9 months. For those with P...
When, if ever, would you consider hippocampal avoidance whole brain radiotherapy in the setting of leptomeningeal disease?
Never. Unless it is nodular leptomeningeal disease recurrence after surgical resection.
Would you treat a Stage I ER/PR positive HER2 negative breast cancer differently if it is associated with Lynch syndrome?
In reviewing the literature, there are a number of articles describing the risk of breast cancer in patients with Lynch syndrome such as this: (Nikitin et al., PMID 32547938). The cliff notes are that in patients with Lynch syndrome and certain mutations, there appears to be a small but definite inc...
Do you hold endocrine therapy during adjuvant breast radiotherapy?
I start endocrine therapy after RT. For one, I don’t think there is a rush to get endocrine therapy going and would rather focus on the patient being able to tolerate it for the long term. And two, if radiation works best on quickly dividing cells, I don’t want to stunt their proliferation (which we...
Do you start systemic therapy for patients with previously localized HR+ breast cancer developing solitary bone metastasis which is now triple negative if there are no other sites of disease after metastasis-directed radiation?
I would start chemotherapy because of the triple-negative status of the metastasis. This is a patient who initially presented with hormone receptor-positive breast cancer and subsequently developed an isolated bone metastasis that was triple negative. The question of systemic therapy post-localized ...