Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer salvage radiation for prostate bed recurrence on PSMA PET in a patient with limited bone mets?
I don’t currently offer salvage post-op RT (PORT) to patients with osseous metastatic disease on PSMA-based PET/CT, which is consistent with the per-protocol treatment strategy on EMPIRE-1 (Jani et al., PMID 33971152). I would, however, be open to offering such a treatment on a clinical trial. An ex...
Is there a role for reirradiation for SCC oral tongue with high-risk features (i.e., PNI, close margins) following surgery?
Consider in patients with ENE, positive margins, deeply infiltrative tumors (>1 cm), or T4. Avoid if <6 mo from prior RT, ongoing wound healing issues in target, or pre-existing severe toxicity (e.g., ORN, severe fibrosis), though this is conditional.
Are there any bladder constraints for preoperative short course rectal RT?
While I appreciate thoughts on constraints by Fields et al., PMID 31673654 (14 patients), or even our paper from Myerson et al., PMID 24606849 (76 patients), I think these are superseded by the higher level of evidence from the RAPIDO study (462 patients w/ SCRT).The RAPIDO study (appendix F, page 8...
Do you recommend postoperative radiation for spinal cord compression DLBCL?
I would recommend postoperative RT, following completion of systemic therapy. I would restage with PET-CT prior to RT. If CR: 30 Gy would suffice.
Would you recommend post operative radiation in an adult patient with a thoracic spine osteosarcoma?
The following answer is extrapolated from AOST2032 which is a pediatric clinical trial but is relevant to the question at hand. This case touches upon the concepts outlined in the AOST2032 research protocol for osteosarcoma radiation therapy. While acknowledging this is just one protocol and not a ...
In the post Covid era, could the ILROG hypofractionated regimens (published as "emergency guidelines" for lymphoma) be considered as standard of care for ISRT?
In palliative settings, we have utilized hypofractionated regimens in hematologic malignancies for decades. Examples include 4 Gy X 1 for follicular lymphoma, 4 Gy X 5 for myeloma, 3 Gy X 10 for DLBCL, and 4 Gy X 2 for mycosis fungoides. In select circumstances (both before and after COVID-19), I ha...
How would you treat a symptomatic tongue metastasis?
It is a very broad question. Assuming wide spread mets from a subclavicular primary, I tend to favor standard palliative regimens, and in head and neck sites, I find a quad shot with potential for repeating 1 or 2 times if responsive, very appealing, especially in patients with poorer PS/poor progno...
Do you recommend holding a KRAS inhibitor during palliative radiotherapy?
I have no personal experience or anecdotes and know of no current data or literature that would address this very specific question and this may be due to the limited experience on the potential interaction of this class of drugs and radiotherapy, since this drug is relatively new.This class of drug...
What are your top takeaways in Thoracic Cancers from ASCO 2022?
1. Abst 8502 - Quality metrics and survival after lung cancer surgery: More efficient work-ups and consistently high quality resections will likely do more to improve lung cancer survival than any adjuvant or neo-adjuvant therapy we can come up with. This is low-hanging, low-cost fruit. 2. Abst 9007...
What are your top takeaways in Thoracic Cancers from ASCO 2023?
Always so hard to pick a top 3 as luckily each ASCO provides us with a broad spectrum of significant advances in our field but if pressed against the wall, I might pick below 3: The first is a double dip choice I admit matching ADAURA with KN789. Of course, you need to be living in a cave not to be ...