Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
How do you sequence Ra-223 and Lu-177 in patients with mCRPC with predominantly bony disease?
The RALU study (Rahbar et al., PMID 36302656) really is quite a small 49-patient cohort study looking at the one-way question of the safety of PSMA-Lu177 in carefully selected patients who had adequate marrow function after both an ARSI, taxane chemo, and radium-223. While these selected patients to...
Would you consider omitting adjuvant radiation in a very elderly patient with a small triple negative breast cancer?
Elderly isn't quantitative or qualitative. Would want to know performance status/life expectancy.Occasionally, patients have had enough and they don't want further treatment after surgery.I presume they also will not receive chemotherapy. If breast cancer takes her life, it will be because of distan...
Which patients, if any, treated according to PROSPECT for an early stage rectal cancer, would you offer surveillance if they achieved cCR after neoadjuvant chemotherapy?
Thanks for the important question. This is a nice but also challenging situation given, at this time, we do not have evidence for organ preservation with chemotherapy alone. Nonetheless, the PROSPECT trial did show approximately 20% of patients indeed achieved pathological compete response (was quit...
Is there a rationale for treating medically inoperable stage I-III breast cancer patients with RT alone?
We treated stage III patients with "radical radiotherapy" with or without chemotherapy when I was a resident in the early 1980s, since they were considered SURGICALLY inoperable then. However, very high doses were needed (75-80 Gy to the primary using external beam followed by interstitial implants)...
How would you treat a patient with synchronous node positive prostate cancer (T3bN1M0) and oligometastatic rectosigmoid cancer (T4aN1M1) with a solitary liver metastasis?
I reached out to my colleague, Dr. @Dr. First Last, a radiation oncologist and co-director of the Prostate Cancer Center at Dana Farber, who has expertise in both genitourinary and gastrointestinal cancers for his thoughts on this question. Here is his answer: Recognizing that the rectal cancer is l...
Is it necessary to treat pelvic lymph nodes for muscle invasive bladder cancer?
You're correct that there is considerable variability in the target used in bladder radiotherapy. We performed a survey of radiation oncologists regarding bladder cancer radiotherapy patterns and found that ~60% use a "small pelvis," ~30% use a true whole pelvis, and ~10% treat the bladder only [1]....