Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there evidence that prostatectomy improves overall survival in local recurrence of prostate cancer post-definitive radiation?
I am not aware of any prospective clinical trial data to suggest that salvage prostatectomy for locally recurrent prostate cancer improves overall survival as compared to any other comparator. Such evidence would be very difficult to generate given that historically, most prospective studies have fo...
How would your recommendations for post-mastectomy radiation change for a patient with scleroderma?
Scleroderma poses challenges for post-mastectomy RT but patients can be treated if needed. 1. I have asked breast surgeons to not omit ALND and proceed with + SLN. If low ratio nodal disease can consider omitting RT, particularly with favorable biology and no other high risk features. For other case...
What are your dose constraints for lung (V20, V5, MLD, etc.) in patients receiving postoperative radiation therapy after lobectomy?
It's recommended to use the LUNG-ART protocol for post-op cases. They utilized the Graham data for V20, but because there was no data for post-op cases where patients don't have part of their lungs, they just modified the contstraint to V20 < 31% for patients treated with lobectomy and V20 < 22% for...
Under what conditions would you offer observation for asymptomatic low volume brain metastases?
This is becoming an increasingly more common scenario with patients undergoing routine brain MR for staging, even in the absence of symptoms, and also, with a very modestly small number of settings demonstrating excellent radiographic responses to targeted agent or immune checkpoint inhibitors (ICI)...
How was treatment response assessed on the PROSPECT trial?
Dr. Harvey reached out to his colleague, Dr. Marc Gollub, director of radiology at Memorial Sloan Kettering with expertise in gastrointestinal imaging (and who was the radiologist who collaborated on PROSPECT), for his thoughts on this question. Here is his answer: I had to “create” a non-volum...
While we await the completion of RTOG 1008, what instances do you offer chemotherapy for salivary gland tumors?
There are no current prospective data about adding chemotherapy to definitive or adjuvant RT for high-grade salivary gland tumors. Data from the National Cancer data base suggested no improvement of post-op CRT compared with RT (Amini A et al, Jama Otolaryngol-HN Surg 2016), however there were more ...
How would you approach adjuvant treatment in a patient with completely resected undifferentiated pleomorphic sarcoma of the chest wall that recurred after 2 years, initially treated with neoadjuvant radiation and resection?
There is no evidence to support adjuvant treatment after re-resection. In the case of recurrence, we prefer to biopsy the mass to prove recurrence and obtain tissue (for NGS). In the case of recurrence, if we were to give systemic therapy, then we would favor neoadjuvant chemotherapy- provided this ...
What is the role of EBRT/brachytherapy (as an addition to chemotherapy) in the adjuvant management of optimally debulked stage IV uterine serous carcinoma?
There is no prospective study in this setting and based on limited retrospective data we do consider adjuvant RT for optimally debulked (meaning no macroscopic disease left behind after surgery) disease. We do consider pre surgery bulk of disease in decision making and would recommend RT for those w...
Can radiation therapy alone for localized recurrence of high-grade B-cell lymphoma be considered for those that previously received rituximab-based chemotherapy?
High-grade B-cell lymphomas are distinct entities no longer classified as "diffuse large B-cell lymphoma" by the WHO. They include: High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (often referred to as double hit or triple hit lymphoma). High-grade B-cell lymphoma, NOS (thes...
How does prior prostate artery embolization impact your treatment recommendations for prostate cancer?
PAE is a "newer" modality that is being used to treat LUTS in men with BPH and BPH symptoms at baseline. Case series report relatively impressive results, with the average AUA score dropping from around 20 to 8 in populations receiving this therapy. PAE is sold as a procedure that is unlikely to hav...