Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What RT dose would you use to treat a single site relapse of high risk multiple myeloma?
Depending on the KPS of the patient, it may be 20 Gy in 5 to 36 Gy in 20. Data (Oertel et al., PMID 30987659) support upwards of over 45 Gy, but that is in the de-novo situation. This is post-treatment/transplant and represents a treatment failure and likely palliation. A 2005 paper on this subject ...
Do you deliver prostate SBRT every other day or consecutively?
Morgan S et al just published Hypofractionated radiation therapy for localized prostate cancer: Executive summary of an ASTRO, ASCO, and AUA Evidence-Based Guideline. It's an article in press in PRO right now. Question KQ4C addresses this question of daily fractionation and in the summary they writ...
When is SBRT or hypofractionated radiation appropriate as adjuvant treatment for pancreatic cancer?
There may be a variety of opinions about this question. 33 Gy in 5 looks to be as least as good as 50.4 Gy in 28 in unresectable pancreatic cancer and has had some improved pathologic responses in borderline resectable pancreatic cancer in experienced hands (Hermann et al., PMID 25538019). However, ...
Have the breast surgeons at your institution adopted the SOUND trial into their clinical practice?
Not at our institution with this practice still being limited to 70 and above.
When do you consider lymphadenectomy vs pelvic lymph node RT in a lymph node recurrence after prior prostatectomy or prostate-only RT?
I typically recommend a modified GETUG P07 (OLIGOPELVIS) treatment paradigm in this setting because I believe it has a favorable toxicity and short term treatment efficacy as well as the best evidence basis at this time. This regimen consists of a fractionated, extended pelvic nodal field with conco...
When would you opt to manage anal squamous cell carcinoma, HPV+ with surveillance vs adjuvant treatment following a trans-anal excision?
Never
How would you manage adjuvant therapy for a patient with pulmonary adenoid cystic carcinoma s/p resection with positive bronchial and vascular margins and nodal involvement?
Manage with adjuvant radiation. No role for systemic therapy concurrently or in adjuvant.
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...