Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How does the presence of indeterminate lymphadenopathy on PSMA PET scan alter your management of unfavorable intermediate-risk prostate cancer?
Summary: In practice, I usually review the imaging myself and attempt to evaluate for common pitfalls of interpretation or evidence that may convince me of a true positive. Often, I find a second review by a blinded radiologist helpful. Unless I am highly suspicious of a false positive, I often err ...
How would you approach radiation for node-positive prostate cancer in a patient with an aortic and/or common iliac arterial aneurysm not meeting criteria for surgical repair?
Literature has shown a correlation of brain irradiation associated with the development of intracranial aneurysms - I believe that is the concern this question is raising.The good news is that other studies have shown that, at least for the aorta, existing large artery aneurysms are not worsened by ...
Is there a limit to the size of a prostate cancer oligometastasis for SBRT?
I think that, in general, the direct answer to this is 'no'; there is no specific size cutoff that makes SBRT not feasible in this setting. There is some data in other settings that suggest local control is not consistently impacted by the size of oligometastatic tumors, and there is little data to ...
How would you approach reirradiation in a patient with a history of whole-breast RT many years ago, now with a small intermediate-grade DCIS s/p lumpectomy with an elevated DCISionRT?
I would favor PBI with 40 in 15 or 45 in 30 (BID) with VMAT/IMRT.
What are the treatment options for a patient with unfavorable intermediate risk PCa who desires future child bearing?
The best option for such patients would be sperm banking prior to treatment, whether they undergo RT+ADT or surgery. See this prior post on this forum regarding the impact of RT on fertility. Given the expected internal scatter dose to the testes during a course of fractionated RT, it would not be s...
Under what circumstances would brachytherapy be preferred over electron therapy for treating skin cancers?
For small (<2 cm) nonmelanoma skin cancers, I would say that brachytherapy is preferred for these reasons: Better cosmesis - 90-95% report excellent, which is better than electron series, particularly at the edge. Better for curved surfaces like the nose b/c applicator is flush on the skin with no ...
In light of the pending overall survival data and reported declines in quality of life associated with the PSMAddition trial, how do you envision incorporating Pluvicto into the management of mHSPC?
The PSMAddition trial was a phase III trial of [177Lu]Lu-PSMA-617 (i.e., Pluvicto) combined with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI) in patients with PSMA-positive metastatic hormone-sensitive prostate cancer (mHSPC). This trial randomized men with u...
What are your recommendations for holding bevacizumab before and after SBRT to the lung?
As @Maria Werner-Wasik notes, our experience at Memorial Sloan Kettering has indicated that giving SBRT for ultra-central lung tumors in a patient who has also been exposed to VEGF inhibitors may be an extremely dangerous combination associated with a high risk of fatal pulmonary hemorrhage. This wo...
How do you determine dose for prostate SBRT?
The Stanford experience published by King et al was an important one describing a prospective experience of SBRT at dose levels of 35-36.25 Gy, and these dose levels were used based upon prior single institution retrospective reports from community practice settings where a good deal of experience ...
Would you omit RNI in a patient with locally advanced TNBC with N1 disease who has an ALND and is found to have a pCR in the nodes?
This is the topic of the NRG B-51 randomized clinical trial which recently closed to new patient accrual. Until we have data from this trial, my default will be to prefer RNI in my triple negative patients known to have nodal involvement at the time of diagnosis, even if they experience a nodal pCR....