Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your approach for PMRT when the patient has a DIEP flap?
I would say that the presence of a DIEP flap does not change my approach to PMRT much. I look to cover the chest wall and regional nodes (+/- IM nodes) similar to a flat chest wall or expander/implant case. In my experience, the only change that sometimes happens is planning as the DIEP can sometime...
What is your criteria for undetectable PSA value after prostatectomy?
In the era of ultra-sensitive PSA, reading below threshold of .2 ng/ml also reflects biochemical recurrence especially in the right context. That being said, if values are low like above, we generally repeat PSA to see the trend rather than act on treatment on single value.
Can you safely proceed with breast irradiation during treatment with immunotherapy?
In KEYNOTE-522, RT was done with concurrent Pembro after NACT plus IO and no significant additional untoward effect was reported. So, we do RT routinely with Pembro for these patients.
Would you offer salvage radiation for a local recurrence of prostate cancer that was initially treated with SBRT?
At this time, I’m not sure there is enough data to recommend a course of re-irradiation after primary SBRT outside of a clinical trial, although I do know some who offer it. The majority of the data regarding re-irradiation for local recurrence after RT comes from smaller retrospective reports, alth...
Is it time to re-evaluate the timing of radiation and chemotherapy with the adoption of hypofractionated courses of radiation for breast cancer?
Clinicians began treating patients commonly with both RT and chemotherapy (CT) in the 1970s and 1980s. They tried many approaches, including giving RT first; giving all CT first; giving a "sandwich" of several cycles of CT, then RT, then completing CT; and giving concurrent RT and CT, with RT starte...
In light of PORTEC-3 and GOG 249 data, do you use adjuvant radiation therapy alone in stage Ib serous endometrial carcinoma?
The answer is still not clear but these studies do suggest limited impact of chemotherapy in early stage adverse pathology endometrial cancer. The confounding factor is that these studies combined clear cell and UPSC together and which diluted the power of the study. Chemosensitivity of CC is not sa...
Would you recommend a simultaneous integrated boost with hypofractionated whole breast radiation?
With the presentation of IMPORT HIGH trial (CRUK/06/003) at SABCS last month, the data for simultaneous integrated boost SIB in breast cancer is accumulating. This was a phase III trial that randomized 2,617 women to a sequential boost (50Gy +16Gy), SIB arm (40Gy to breast with 48 Gy to boost volume...
Do you try to incorporate mFOLFIRINOX in total neoadjuvant therapy for rectal cancer?
PRODIGE 23 study is an open-label, randomized phase 3 study (Conroy et al., PMID 33862000). Locally advanced rectal cancer patients (cT3 or cT4 M0) were randomized to either the study arm (mFOLFIRINOX X 3 months, chemoradiation, TME, FOLFOX X 3 months) or the standard arm (chemoradiation followed by...
How would you approach a patient with invasive breast cancer and DCIS s/p mastectomy and immediate reconstruction with a negative invasive margin, but a close DCIS margins?
I would observe such a patient. With a close DCIS margin post mastectomy, there is very little evidence of a benefit to PMRT. Subsequent local recurrence is well below 10% so I see no clear role for PMRT in such a case. Even if there was a close invasive margin unless there were other aggressive fac...
For multiple myeloma, is 8 Gy in 1 fraction an appropriate palliative dose, although this histology was excluded from trials examining a single fraction?
There was a randomized trial comparing 8 Gy/1 fx vs 30 Gy/10 fx for patients with multiple myeloma. There was no difference in analgesic response or recalcification, however patients with the protracted regimen seemed to have a benefit in terms of QOL. However, the the control arm (30 Gy in 10), th...