Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer focal prostate boost per FLAME protocol for GTV defined by PET alone without MRI?
I think there are two questions here: Can you use PSMA PET to define the boost target? Yes (with a little bit of caution). There have been several reports on the safety/feasibility of PSMA-based focal boost. Note, though, that FLAME was based on MRI, and we can expect that the PET-defined lesion may...
For patients with primary CNS lymphoma and less than a CR to chemotherapy, in what situation would you consider partial or focal radiation?
For the sake of discussion, I will assume that this patient achieved a PR after a high-dose MTX regimen. If the patient is young (<60 yo) and has a good KPS (>70), I would consider using a reduced dose of WBRT (30-36) followed by a boost to the residual lesion to an equivalent dose of 45 Gy (either ...
How would you treat a synchronous low rectal adenocarcinoma and anal squamous cell carcinoma with involved pelvic and inguinal nodes?
If the patient has intact bowel/anal sphincter function at baseline, I’d favor an organ-preserving approach. I’d treat with standard pelvic + inguinal chemoradiation with a dose/fractionation scheme isoeffective with 45 Gy in 25 fractions targeting pelvis/inguinals and a dose isoeffective with 54-56...
What are your top takeaways from ASCO GU 2024?
Prostate. BRCAAway. This small but important phase 2 randomized multicenter trial of HRRm mCRPC in the first line setting demonstrated the clear synergy in delaying progression or death and inducing better response between abiraterone and olaparib as compared to either abi or olaparib monotherapy o...
For recurrent glioblastoma treated with combined re-irradiation and bevacizumab, how long do you continue bevacizumab?
In the event of recurrent GBM, for example, if i.e. fSRT regimen like 30 Gy/5fx to be used for salvage, would not exceed more than 12 doses (6 cycles) of bevacizumab max. Even in the pseudo-response setting, the toxicity far outweighs the benefit beyond this.
What is the role of radiation therapy for an elderly patient with medullary thyroid cancer who is not a surgical candidate?
We have offered definitive RT for MTC patients who are medically or surgically unresectable. Dosing is variable based on involved structures, performance status, staging, etc. We have used 5400 cGy in 18 fractions, particularly for the more elderly, poor performance status patients. Coverage of elec...
What is the appropriate dose/fractionation when treating a dermatofibrosarcoma protuberans of the spine following debulking surgery in a patient with a good performance status?
Certainly, a challenging circumstance. With DFSP, pathology review is critical to evaluate for transformation to more aggressive variants with higher malignant potential. Clinically, DFSP is usually present for decades and extremely slow growing. Sudden changes in growth rate are concerning for tran...
What options do you have when a patient has urinary obstruction during radiation treatment?
Here is my general practice on urinary symptom management for a man with prostate cancer undergoing RT.Urinary symptom management RT can decrease urinary symptoms in men with irritable urinary symptoms (http://www.ncbi.nlm.nih.gov/pubmed/20643513) - not sure of mechanism but it takes time to see th...
How do you define your post-operative treatment volumes for a patient with a resected high-grade soft tissue sarcoma of the soft tissues of the upper back?
Thank you for this question. My concern with the lack of pre-surgical imaging is that there is not a good delineation of tumor extent. In scenarios of non-oncologic resection or resection without prior imaging, one should be wary of this. As such, my recommendation would be to be more generous with ...
Can venetoclax and radiation be safely given concurrently?
There is a recent retrospective review by Ho et al which looked at the toxicity profiles associated with "novel" oral lymphoma agents of ibrutinib, venetoclax, and lenalidomide concurrent with radiation treatment for lymphoma, as compared to sequential therapy of novel agent followed by RT (separate...