Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
With the presentation of HypoG-01 phase III UNICANCER trial at ESMO 2024, should hypofractionated radiotherapy be the standard across the board for breast cancer?
It would be difficult not to recommend at this time.HypoG-01 had broad criteria and did not show any differences in outcomes in terms of disease control or toxicity between 40/15 vs 50/25. RT-CHARM was all reconstructed PMRT patients showed a slightly higher risk of complications with the hypofracti...
Is prior radioembolization with Yttrium-90 microspheres for a primary liver cancer a contra-indication to external beam radiation therapy with either stereotactic body radiation therapy (SBRT) or proton beam therapy?
Great question. The original ACR SIRT/RE guideline listed previous external beam as a relative contraindication to Y90 RE.*RE is safe for patients who have had "minimal prior exposure" to external beam radiation. While there is limited published literature on the combination of RE and EBRT/SBRT, one...
Can radium-223 be given to prostate cancer patients with a history of visceral metastatic disease?
Radium-223 is a bone-targeted radiopharmaceutical. In the ALSYMPCA trial, patients with visceral metastases or lymphadenopathy>3cm were excluded. However, if a patient with mCRPC has visceral disease that resolved with previous treatment, and now has progressive osseous metastases, it would be very ...
How do you approach patients with SMARCB1 deficient sinonasal carcinoma for immunotherapy?
Sinonasal cancers that are SMARCB1-deficient are rare. They tend to be more aggressive, present in more advanced stages, and tend to be associated with non-keratinizing histology. Despite this, there are no guidelines for a differential approach for these tumors and they are treated in a similar fas...
How are you modifying your current sarcoma-directed therapy in the setting of the COVID-19 pandemic?
Here are the guidelines at Fox Chase Cancer Center by Margaret von Mehren MD, @Dr. First Last , Jeffrey Farma MD, Sanjay Reddy MD, John Abraham, MD, and Stephanie Greco, MD I. Management of STS during COVID-19 Pandemic: During the current pandemic, care will need to be changed to allow for hospitals...
When treating high grade gliomas abutting critical structures, how do you balance tumor dose with critical structure constraints?
The CTV should be shaved away from critical structures if they are likely not to be involved with tumor. That said, expansion with PTV can put dose back into these critical structures and it may be hard to achieve full coverage without exceeding critical structure constraints. Although for PTV, we a...
Would you offer SBRT for a lung lesion adjacent to the heart in a patient receiving bevacizumab?
This question has lingered. Why is the patient on bevacizumab? Is the lesion biopsied and distinct histology? SBRT can be delivered in as few as 1 or 3 fractions, motion managed with no or mm margins. Hold the anti-VEGF a week before and after (no data). A biopsy helps define malignancy type and pot...
Would you ever consider repeating chemoradiation for patients with locally recurrent small cell lung cancer after prior chemoradiation for LS-SCLC?
I have re-treated in-field local recurrence SCLC advising thoracic radiotherapy first using SBRT dose and technique. Also, new lung cancers are more common in those who could not stop smoking.
When treating borderline resectable pancreatic adenocarcinoma patients with neoadjuvant chemoradiation, do you treat the elective nodal regions or the primary alone?
This is a very reasonable question without a clear answer, and I'd be interested in seeing how other people respond. As I've mentioned in a previous pancreatic cancer discussion on this forum, there are ongoing trials to evaluate whether radiation improves outcome in the resectable setting (RTOG 084...
Given improved BFS from the phase III FLAME trial, do you recommend focal SIB up to 95 Gy for unfavorable and high risk prostate patients?
As yet, I have not tried to dose escalate to that level using EBRT, preferring to use a brachytherapy boost if I feel patients might require more than I can safely deliver to the whole gland using IMRT. That said, however, I do not think that it would be wrong to try to deliver a focal boost using I...