Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can radiation to the breast be given in the setting of prior radiation for Hodgkin's lymphoma?
Based on previous dose and volume (as most people are getting ISRT and between 20-30 Gy), either whole breast or partial breast RT are usually options. One concern I have is the increase IBTR which is most likely new primary in these patients because of prior RT exposure (akin to BRCA mutation).
After the results of RTOG 0232, would you be comfortable treating unfavorable intermediate risk prostate cancer with brachytherapy monotherapy?
I would not necessarily be comfortable treating every unfavorable intermediate risk (UIR) patient with LDR brachytherapy alone (nor with HDR brachy alone). My reason for this is that 0232 only included about 50 patients in each arm with Grade Group 3 tumors, and no information is available about per...
Why do the most recent NCCN guidelines (Version 4.2024, 05/17/24) omit the duration of ADT for high-risk prostate cancer patients?
No idea, but version 1.2025 (accessed 12/10/2024) now includes ADT duration for high-risk, which is 12-36 months, with notes indicating, "For high-risk and very-high-risk prostate cancer treated with combination EBRT brachytherapy, a shortened duration of ADT (12 months) can be considered." For high...
Would you include the entire bladder in the treatment field of a patient with a history of T1 bladder cancer s/p intravesical therapy who is now being planned for chemoradiation for a T3N1 rectal cancer?
No, I would NOT include the entire bladder in the treatment field. The major driving factor for his survivorship will be rectal cancer (instead of bladder cancer) in his case. Given that his superficial bladder cancer is relapse-free for 2 years, his outlook from a bladder cancer perspective is favo...
What normal tissue dose constraints do you use when delivering up to 3 cycles of the palliative quad shot regimen for gynecologic pelvic malignancies?
I don’t follow fixed dose constraints but adjust based on the volume of disease and the volume to treat.
Is it ever reasonable to offer EBRT alone for a patient with high risk prostate cancer?
I think there could be 3 broad reasons to consider not combining RT with ADT for high risk prostate cancer: Disease risk: If a patient falls into a more favorable part of the high risk spectrum (e.g. high risk by PSA only, MRI without ECE/SVI/LNI/larger nodule size, or perhaps lower-risk genomic cla...
When do you recommend preop RT for retroperitoneal sarcomas?
I imagine I'm not alone in feeling a tad frustrated with the STRASS trial results, not because of the negative primary endpoint in regards to radiotherapy, but because it failed to clearly answer the question it was supposed to.In brief, the STRASS trial was a 2-arm randomized controlled trial of su...
Would you offer adjuvant radiation therapy in a young adult with NF1 who has a craniopharyngioma s/p STR?
In NF1 patients, radiation therapy for craniopharyngioma has been associated with vascular damage and Moya Moya syndrome. On the other hand, subtotally resected craniopharyngiomas have a high chance of recurrence. It has been shown that, dosimetrically, intensity-modulated proton therapy (IMPT) coul...
How do you incorporate absolute percent pattern 4 (APP4) into your risk stratification, specifically your recommendation for ADT for intermediate prostate cancer?
Summary: The short answer is that APP4 is unlikely to improve risk prognostication to the extent to which other advanced biomarkers (GC, MMAI, etc.) do. It is also unlikely either alone or in combination with standard clinical factors to serve as a predictive biomarker. Nevertheless, it is certainly...
Do you treat inguinal lymph nodes for rectal cancers involving the anal canal?
One of my residents recently told me that I should treat the inguinal nodes for low lying rectal cancers based on recommendations on the MedNet. I realized this is an old post, but I would like to add a nice reference that really convinced me that there is probably minimal benefit to treating inguin...