Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach de novo metastatic castrate sensitive prostate cancer with extensive locoregional spread causing rectal compression, retroperitoneal lymphadenopathy, and PSA >3000 but no visceral or bone metastases?
It sounds like from the question that the patient has T4 disease invading the rectum. This makes the patient ineligible for surgical resection with curative intent. He might still be a candidate for curative intent radiation therapy/ADT +/- abiraterone per STAMPEDE. His highly elevated PSA is very w...
Would you recommend surgery or stereotactic radiation therapy for a young woman with high-grade serous ovarian cancer presenting with a pelvic LN oligometastasis following maintenance therapy?
Like OM, the principle for other cancer favors SBRT as has excellent local control and low morbidity Donovan et al., PMID 38869888
How do you define the suprapubic volume for adjuvant penile cancer treatment?
A recent publication (Cooper et al., PMID 40180061) from the InPACT (NCT02305654) investigators, representing an international group consensus on both indications for RT and target volume delineation for penile cancer, may be helpful. This publication gives some guidance into the definition of this ...
How would you treat progressive Rosai Dorfman Destombes disease after initial limited radiation therapy?
To provide the best answer, we need a little more detail on this case. Also, is the patient symptomatic from the abdominal disease? If not, I would observe in the short term. If symptomatic, I would do PET/CT and consider a repeat biopsy, given the risk of the development of another process. Do you ...
For merkel cell carcinoma of the eyelid, how do you approach post-operative management and what are the recommended radiation treatment volumes?
RT to the primary site with a 2-3 cm margin preferably with 250 kVp otherwise 6 MeV. Eye shield and lead mask. Elective RT to parotid and ipsilateral neck.
When, if ever, would you consider dose de-escalation for HPV-associated non-oropharyngeal HNSCC?
This is a very complex question, as the issues of dose, and de-escalation can be difficult to sum up in an hour lecture let alone a Mednet query. Personally, for me, efforts to lessen volume and doses to subclinical disease are a bit more interesting.Quoting Cmelak et al., PMID 34043410 (2021) in an...
What percentage of your breast cancer patients do you plan using IMRT vs 3D?
I think this happens to hinge on your definition of IMRT. Until it became a billing issue, FiF/forward planned segmented treatments were known as IMRT. When it became concerning that billing these as IMRT would become costly for Medicare and commercial payors, the radiation oncology did some sleight...
At what PSA level would you consider restaging a patient who was treated with ADT and radiation and had undetectable PSA?
The criteria for defining PSA relapse after radiation therapy remains the Phoenix criteria (see Roach et al., PMID 16798415), which is essentially nadir + a 2 point rise in serum PSA. Thus, a patient who achieves an undetectable PSA on ADT/RT but then experiences a PSA rise would not meet PSA relaps...
Do you use more stringent liver constraints when treating HCC with SBRT in patients who are CP B8/9 or C?
CP C patients are typically excluded from SBRT studies due to unacceptably high toxicity risks. In my practice, I do not offer SBRT to CP C patients. For those with CP B8 or B9 cirrhosis, I aim to spare at least 700 cc of uninvolved liver from receiving 15 Gy or more when delivering 5-fraction SBRT....
Do you routinely use imaging (US, whole body iodine scans etc.) to follow papillary or follicular thyroid cancer after thyroidectomy and RAI therapy?
I am unaware of any prospective data suggesting a DFS or OS benefit to periodic imaging in patients with well differentiated thyroid cancer; that being said, beyond annual MMGs for our breast cancer patients, is there any benefit to any surveillance imaging in any malignancy? That has been recently ...