Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What radiation dose would you use for T4 prostate cancer?
Local therapy for T4 prostate cancer is critical. It needs to get the full dose to ensure good control. There is very little information about the specifics of the radiotherapy, and I don't believe there is any toxicity data specifically for cT4 lesions. However, there is data showing local therapy ...
How do the results of the phase 2 TREASURE trial for consolidative RT for ES-SCLC impact your practice?
Thoracic radiotherapy is defined not only by dose, but critically by treatment volume. The TREASURE protocol permitted large CTV expansions, discretionary irradiation of clinically uninvolved nodal regions, and substantial additional PTV margins. Elective nodal irradiation is not part of contemporar...
Should we delay adjuvant breast radiotherapy for early stage breast cancers as the COVID-19 situation evolves?
This is a very tough question given the unprecedented nature of this pandemic and the fact that its duration is unknown. Recommendations will likely vary based on the density of cases in a specific geographic location and will undoubtedly change frequently given the rapidly evolving nature of this s...
How should radiation oncology departments prepare for significant resource depletion and/or staff shortages with the COVID-19 outbreak?
Resource depletion to the extreme would be analogous to having a non-operational clinic as some experienced during the Hurricane María disaster. I would suggest reading the paper:Lessons Learned From Hurricane Maria in Puerto Rico: Practical Measures to Mitigate the Impact of a Catastrophic Natural ...
Is PMRT considered the standard of care in women with 1-3 positive axillary lymph nodes?
I come to this question with a somewhat different stance than we have traditionally thought. To me, the following things seem clear:1) In our modern randomized trials of PMRT (British Columbia and Danish 82b and c) there was no difference in the OS advantage of RT based on # of positive nodes (1-3 v...
For a patient with localized, high-risk prostate cancer (Gleason >8, staged with PSMA PET), is prostate SBRT a reasonable treatment choice, and if so, what duration of ADT would you utilize in this setting?
Yes, I offer SBRT as a reasonable option for high-risk prostate cancer. This is admittedly an extrapolation from PACE-B, which studied treatment of intermediate-risk cancer, but it seems justified in my view. Safety is well established. Efficacy is supported by PACE-B, with an asterisk coming from N...
Is the PROTEUS data enough to change your practice in the treatment of patients with high-risk localized or locally advanced prostate cancer?
The question asks if the results of PROTEUS would/should impact practice patterns...let us take a look: ADT is not recommended to be used with radical prostatectomy in prostate cancer by any guideline. Apalutamide or any ARPI are not recommended to be used with RP in prostate cancer in any guideline...
Do you use an LAD constraint in the setting of BID thoracic radiation for SCLC?
The literature is convincing that an increasing dose to the heart (using whole-heart dosimetric parameters) is associated with an increased risk of adverse cardiac events and decreased survival. Recent and current investigations have attempted to correlate dose to specific cardiac substructures with...
Would you continue tarlatamab in CNS-only progression of small cell cancer if there is no systemic disease?
I would absolutely continue tarlatamab in this scenario. While there is evidence of at least some activity of tarlatamab in the CNS (e.g., Zhang et al., PMID 40126456), the effect can be transient, suggesting that intra- and extracranial discrepancy is possible/probable. I would handle isolated, oli...
Should we consider radiation therapy for patients with N2 EGFRm NSCLC who will receive osimertinib, though RT was excluded on ADAURA?
For an EGFR-mutant N2 disease, we favor adjuvant chemotherapy (OS benefit) and/or adjuvant TKI based on ADAURA trial (DFS survival). The only prospective data regarding the use of adjuvant radiotherapy comes from a phase III trial, Lung Adjuvant Radiotherapy Trial (Lung-ART), where patients were ran...