Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What margins do you use for GBM volume delineation?
There is an ASTRO consensus guidelines committee currently working on guidelines for glioblastoma. One of the key questions facing the committee is the optimal target volumes for potentially curative radiation therapy. Issues include treatment of FLAIR/T2/edema followed by a boost to the T1 enhancin...
When following active surveillance paradigm, what PSA increase will trigger prostate biopsy?
When using PSA to aid in the decision to re-biopsy a patient on active surveillance, I think you have to consider that the non-malignant prostate tissue also contributes to the rise in the PSA and that there are limits to the accuracy of the test. In patients not known to have prostate cancer, a PSA...
What criteria do you use when selecting a multi-fraction vs single fraction approach for treatment of spine metastases with radiosurgery?
For de novo spine metastasis, I typically use 27 Gy in 3 fractions as default and use a single fraction approach only for logistic reasons (we frequently have patients coming from Hawaii, Guam, Alaska, Montana, Wyoming, Idaho, and eastern Washington).My reasons for using a multiple fraction approach...
Is it safe to use curcumin during cancer treatment?
There is preclinical data that suggests curcumin is a normal tissue radioprotector and a tumor sensitizer. That is a difficult combination to achieve and I am skeptical. There is also preclinical data that it works on a number of patho-physiologic pathways, some common and other specific to particul...
Should PMRT be offered for ypN0(i+) disease if only 1-2 nodes were removed in the post-chemotherapy SLNB and there is no plan for a completion AxLND?
I favor PMRT although they were eligible for B-51 and called N0. Based on the surgical series, the risk of additional positive nodes is 15% to 57% (SN FNAC phase 2 study) and for that reason, treat with comprehensive PMRT.
How do you approach a recurrence of grade 3 anaplastic astrocytoma after initial treatment with gross total resection followed by RT/adjuvant temozolomide?
As the questioner notes, this is an area where guidelines and published evidence are not as satisfying as we would like, so treatment has to be individualized. In addition, most trials until very recently did not test IDH status or 1p/19q status so the diagnoses may not be the same as people diagnos...
Is moderately hypofractionated RT using 60 Gy/20fx with concurrent chemotherapy appropriate for unresectable stage III NSCLC?
No perfect answers, as usual. We (CALGB) did a prospective multi-institutional Phase I trial asking the question, what is the MTD for hypofx treatment with concurrent chemo for stage 3 disease? We came to an MTD of 60 Gy in 24 fx (2.5 gy/fx). Urbanic et al., PMID 29487024. Inclusion was your typical...
Given the PATRIOT trial and hypo-FLAME 2.0, do you consider once-a-week prostate SBRT instead of every other day?
Yes, it is reasonable to offer weekly prostate SBRT to patients.Quick review of evidence: hypo-FLAME 2.0 (De Cock et al., PMID 37178932) was a phase II single-arm trial that used 35 Gy/5 fx with FLAME-style isotoxic SIB up to 50 Gy/5 fx to visible tumor(s) with a bi-weekly schedule. N=124 participan...
Would you consider SBRT to a single nodal recurrence in a patient with previously treated metastatic GEJ adenocarcinoma s/p a complete response to systemic therapy followed by 37.5 Gy to the primary who was NED for 12 months up until this recurrence?
Tough case! I would consider reinitiation of systemic therapy at this time, given the relatively short interval since completion of prior RT as well as concern for short interval progression in other areas without systemic control. After ~4-6 months of systemic therapy, however, if no new sites of m...
Would you recommend hypofractionated PMRT with a positive deep margin?
I have used hypofractionated RT in this setting with final boost to area of positive margin equivalent to 60 Gy