Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For palliation of gastric bleeding due to malignancy, is a G-tube a contraindication for RT?
I would not change my approach because of a G-tube and I base my dose/fractionation largely on performance status. This recent systematic review is helpful and highlights that a low BED regimen is typically adequate for effective palliation (Tey et al., PMID 28445941).
Would you offer salvage radiation for biochemically recurrent prostate cancer with a transplanted pelvic kidney?
You may want to consider a PSMA PET/CT or Fluciclovine PET/CT if the PSA is >=0.2 at 0.2-0.5 about 30% of scans are positive, at 0.5 and up ~ 50% or more. If you had a target it may guide field design. I would also be curious about life expectancy of this patient, PSA doubling time, and time form or...
Is TURP a contraindication for prostate cancer SBRT?
I have not done it, but Georgetown experience recently published here: Pepin et al., PMID 32432033A recent informal Twitter poll shows many are comfortable with SBRT after TURBT: https://twitter.com/TylerSbrt/status/1323315130990432256?s=20I'm interested if any have further insight.
How do you approach a patient with cN0 breast cancer who has high risk features but did not have a sentinel node biopsy?
For T1 and T2 disease, I usually treat levels 1 and 2 in tangent beams.
How would you counsel a young female patient who refuses to use contraception during radiotherapy?
A woman who refuses contraception needs careful psychological and psychiatric assessment and considerable time at the time of consultation to understand why she is refusing, especially since this response is neither rational nor logical. The practitioner needs to take the time to discuss the patient...
Would you consider APBI in an otherwise-suitable patient who has ITC in a sentinel lymph node?
I would treat ITC like node negative and would treat with APBI if otherwise suitable.
Would you offer preoperative radiation for an intrathoracic leiomyosarcoma in the posterior mediastinum?
I would want further details (age, grade, size, specific anatomic relationships, etc), but most likely yes. DOSE AND FIELD: I would typically treat GTV + 1.5 cm anatomically constrained expansion to 50.4/28, plus any suspicious edema on T2 STIR. By analogy with retroperitoneal sarcomas, I think one ...
For patients with Stage IIIB or IV HD flowing Bv-AVEPC with initial large mediastinal adenopathy, how can we avoid ISRT?
It is true that on the clinical trial AHOD1331, patients who presented with large mediastinal adenopathy received radiation therapy as did patients who were slow early responders (Deauville 4 or 5 after two cycles of therapy). It is noteworthy that 3-year event-free survival was extremely high for a...
What are your top takeaways in GU Cancers from ASTRO 2024?
The Presidential Symposium was outstanding. Dr. Brandon Mahal’s presentation hit on a top priority for the field, in my view: how do we improve/accelerate the implementation of advances like focal microboost for prostate cancer? RCT evidence of benefit to dose escalation is rare in rad onc. The FLA...
What are your top takeaways in Thoracic Cancers from ASTRO 2024?
1. Concurrent Chemoradiation ± Atezolizumab (atezo) in Limited-Stage Small Cell Lung Cancer (LS-SCLC): Results of NRG Oncology/Alliance LU005 published in issue: October 01, 2024 S2 Although disappointing, the negative results of this trial reinforce that there is no benefit to concurrent immunother...