Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider adjuvant radiation therapy for a grade 1 meningioma with an elevated Ki67?
An answer to this important question requires conjecture as well as additional details. Ki-67 has indeed in some studies been identified as a promising biomarker [Liu et al., PMID 32118704, Tjuatja et al., PMID 36448071, Chen et al., PMID 29624151], however not uniformly so [Jensen et al., PMID 2929...
How would you manage a patient with PSA persistence after RALP demonstrating metastasis in regional lymph nodes without further evidence of disease on bone or CT scans?
First, if possible, I would try to get a PSMA PET/CT. If that is negative, this patient should be started on long-term ADT. In terms of radiation, if they were a candidate for radical prostatectomy, the age/performance status question is probably not a major concern unless their health status has un...
Would you offer salvage radiation for prostate bed recurrence on PSMA PET in a patient with limited bone mets?
I don’t currently offer salvage post-op RT (PORT) to patients with osseous metastatic disease on PSMA-based PET/CT, which is consistent with the per-protocol treatment strategy on EMPIRE-1 (Jani et al., PMID 33971152). I would, however, be open to offering such a treatment on a clinical trial. An ex...
Is there a role for reirradiation for SCC oral tongue with high-risk features (i.e., PNI, close margins) following surgery?
Consider in patients with ENE, positive margins, deeply infiltrative tumors (>1 cm), or T4. Avoid if <6 mo from prior RT, ongoing wound healing issues in target, or pre-existing severe toxicity (e.g., ORN, severe fibrosis), though this is conditional.
Are there any bladder constraints for preoperative short course rectal RT?
While I appreciate thoughts on constraints by Fields et al., PMID 31673654 (14 patients), or even our paper from Myerson et al., PMID 24606849 (76 patients), I think these are superseded by the higher level of evidence from the RAPIDO study (462 patients w/ SCRT).The RAPIDO study (appendix F, page 8...
Do you recommend postoperative radiation for spinal cord compression DLBCL?
I would recommend postoperative RT, following completion of systemic therapy. I would restage with PET-CT prior to RT. If CR: 30 Gy would suffice.
Would you recommend post operative radiation in an adult patient with a thoracic spine osteosarcoma?
The following answer is extrapolated from AOST2032 which is a pediatric clinical trial but is relevant to the question at hand. This case touches upon the concepts outlined in the AOST2032 research protocol for osteosarcoma radiation therapy. While acknowledging this is just one protocol and not a ...
In the post Covid era, could the ILROG hypofractionated regimens (published as "emergency guidelines" for lymphoma) be considered as standard of care for ISRT?
In palliative settings, we have utilized hypofractionated regimens in hematologic malignancies for decades. Examples include 4 Gy X 1 for follicular lymphoma, 4 Gy X 5 for myeloma, 3 Gy X 10 for DLBCL, and 4 Gy X 2 for mycosis fungoides. In select circumstances (both before and after COVID-19), I ha...
How would you treat a symptomatic tongue metastasis?
It is a very broad question. Assuming wide spread mets from a subclavicular primary, I tend to favor standard palliative regimens, and in head and neck sites, I find a quad shot with potential for repeating 1 or 2 times if responsive, very appealing, especially in patients with poorer PS/poor progno...
How do you weigh upfront nodal burden when deciding to omit PMRT in a patient with cN1, ypN0 disease after neoadjuvant chemo, mastectomy and ALND?
Pre-chemo imaging if it shows 4 or more abnormal nodes (N2) then would offer RNI irrespective of response.