Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In asymptomatic patients with castrate resistant prostate cancer who have failed chemotherapy and have progressive PSMA-avid vertebral body metastases, when do you prescribe lutetium 177 (Pluvicto) vs prophylactic spinal radiation?
It's rarely either/or. I would say that pretty much any patient like the one described in the question should be getting Pluvicto as it has a demonstrated OS benefit. But sometimes the patient may also need more immediate palliation with EBRT before Pluvicto can get up and running. The main issue he...
Do you offer prostate RT to men with 0-3 bone metastases on conventional imaging when PSMA PET shows a very high number of M1 lesions?
This would be a hard no from my standpoint.I get the rationale here. STAMPEDE found a survival benefit for prostate-directed RT in men with "low volume" disease, which was defined based on the CHAARTED trial with conventional imaging. Therefore, men with low-volume disease on conventional imaging fi...
Which patients, if any, do you offer transdermal estradiol as a method of ADT instead of LHRH agonists?
My default form of ADT remains a GnRH agonist or antagonist but estradiol transdermal patches are clearly effective and safe as an alternative option for men who either 1) have significant loss of bone density/osteoporosis, 2) have significant hot flashes with traditional ADT and wish to try an alte...
What would you recommend for a stage I diffuse large B cell lymphoma (IPI 0-1) involving a single lymph node that is completely removed with an excisional biopsy?
Some more info woud be helpful such as age of pt, size and location of node, margins of resection. In general 6 cycles of RCHOP is prefered with RT in almost all instances. 3 cycles is reserved for the most favorable patients. I would add ISRT adhering to recent guidelines from Intl Lymphoma Radiati...
What RT fields would you recommend for a patient with early-stage diffuse large B-cell lymphoma who refuses or is unfit for systemic therapy?
For a patient with stage I DLBCL, RT fields should encompass the involved site with a generous margin, the latter not precisely defined but dependent on what the site is and what side effects need to be considered with larger volumes. RT fields should not change much if the patient is not receiving ...
Does long term use of 5 alpha reductase inhibitors change the way you evaluate a PSMA PET?
I am not aware of any specific studies that answer this question, but you could consider this situation similar to a patient on ADT, where there is the possibility that treatment may reduce the sensitivity of imaging. (n.b., a prior post discusses the influence of ADT on PSMA-based PET/CT). In this ...
For men with intermediate or high-risk prostate cancer, can an SBRT boost be used in place of a brachytherapy boost after EBRT?
I would respectfully disagree with @Dr. First Last and @Dr. First Last on this subject. Probably because the issue is much more complicated than they elude.One thing that is not complicated is that dose is dose. Or rather effective dose is effective dose. So any method of accurately delivering that ...
Is it appropriate to re-consider bladder preservation in patients with bladder muscle-invasive cancer (T2) who were initially poor candidates for BP (multifocal disease, etc.) but had complete response after neoadjuvant chemotherapy?
It is perfectly appropriate. There are many ways to achieve a complete response to T2 bladder cancer. It can be reached with radiation, an aggressive local resection, or chemotherapy. The issue is whether or not it is durable. None of these therapies alone have a great track record, although chemoth...
Do you use different dose constraints for large bowel vs. small bowel?
I am not going to exactly answer this question, but rather give some thoughts on the issue of bowel tolerance. I think we need to be careful in just plugging in numerical constraints but need to consider the question more broadly. There are good data to show that small volumes of rectum can tolerate...
Do you recommend neoadjuvant and concurrent ADT vs concurrent ADT for salvage post prostatectomy radiation?
I do both neoadjuvant and concurrent. The strategy used is typically dictated by patient schedule/convenience.While GETUG-AFU 16 used a concurrent approach, SPPORT utilized a 2-month neoadjuvant strategy for ADT.